Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT60353079 | WA |
N | 2251S0007X | Physical Therapist - Sports | 62-025598 | NY |
N | 2251X0800X | Physical Therapist - Orthopedic | 62-025598 | NY |
NPI | 1417108762 |
---|---|
Provider Name | Mr. Christopher Darren Johnson |
First Address | Bellevue, WA 98004-8614 |
Second Address | Bellevue, WA 98004-8614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2008 |
Last Update Date | 14/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G8918492 | (02) | WA |