Provider Demographics
NPI:1932580016
Name:JOHNSON, RUPERT
Entity Type:Individual
Prefix:
First Name:RUPERT
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 870
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-0870
Mailing Address - Country:US
Mailing Address - Phone:877-312-6576
Mailing Address - Fax:814-506-8213
Practice Address - Street 1:1000 PINE ST
Practice Address - Street 2:
Practice Address - City:RENOVO
Practice Address - State:PA
Practice Address - Zip Code:17764-1624
Practice Address - Country:US
Practice Address - Phone:570-923-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-14
Last Update Date:2015-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist