Provider Demographics
NPI:1982729968
Name:JOHNSON PHYSICAL THERAPY AND REHAB PC
Entity Type:Organization
Organization Name:JOHNSON PHYSICAL THERAPY AND REHAB PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND STAFF THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:NAJIB
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:970-564-0311
Mailing Address - Street 1:1280 N MILDRED RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-2212
Mailing Address - Country:US
Mailing Address - Phone:970-564-0311
Mailing Address - Fax:970-564-0313
Practice Address - Street 1:1280 N MILDRED RD STE 2
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-2212
Practice Address - Country:US
Practice Address - Phone:970-564-0311
Practice Address - Fax:970-564-0313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4149225100000X
CO8305225100000X
CO6724225100000X
CO12733225100000X
CO12784225100000X
225100000X, 225X00000X, 332B00000X, 332BC3200X
CO1284225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71952543Medicaid
CO4629310001Medicare NSC
CO468928Medicare UPIN