1356629943 NPI number — MR. HENRY AARON JOHNSON PHYSICAL THERAPIST

Table of content: MR. HENRY AARON JOHNSON PHYSICAL THERAPIST (NPI 1356629943)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356629943 NPI number — MR. HENRY AARON JOHNSON PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
JOHNSON

Provider First Name:
HENRY

Provider Middle Name:
AARON

Provider Name Prefix Text:
MR.

Provider Name Suffix Text:

Provider Credential Text:
PHYSICAL THERAPIST

Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:
JOHNSON

Provider Other First Name:
HENRY

Provider Other Middle Name:
AARON

Provider Other Name Prefix Text:
MR.

Provider Other Name Suffix Text:

Provider Other Credential Text:
PHYSICAL THERAPIST

Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1356629943

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
07/29/2011

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 324

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
FORT MORGAN

Provider Business Mailing Address State Name:
CO

Provider Business Mailing Address Postal Code:
80701-0324

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
208-431-6931

Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
716 COLFAX ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:
FORT MORGAN

Provider Business Practice Location Address State Name:
CO

Provider Business Practice Location Address Postal Code:
80701-4084

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
208-431-6931

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:
07/29/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

Provider Taxonomy Codes

Taxonomy code: 225100000X , with the licence number: 1152 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .