Provider Demographics
NPI:1811060502
Name:JOHNSON, JOEL M (PT)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4361 TALBOT RD SO
Mailing Address - Street 2:STE 100
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055
Mailing Address - Country:US
Mailing Address - Phone:425-917-9885
Mailing Address - Fax:425-917-2334
Practice Address - Street 1:4361 TALBOT RD SO
Practice Address - Street 2:STE 100
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055
Practice Address - Country:US
Practice Address - Phone:425-917-9885
Practice Address - Fax:425-917-2334
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002862225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8351397Medicaid
WA5324JOOtherREGENCE BS
WA147035OtherDEPT OF L & I
WA5324JOOtherREGENCE BS