Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT013576L | PA |
NPI | 1255995312 |
---|---|
Provider Name | David Paul Johnson |
First Address | Spring Brook Township, PA 18444-6439 |
Second Address | Taylor, PA 18517-2012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2019 |
Last Update Date | 24/04/2019 |