1508844069 NPI number — RICHARD J JOHNSON PT

Table of content: RICHARD J JOHNSON PT (NPI 1508844069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508844069 NPI number — RICHARD J JOHNSON PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
RICHARD
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
RICK
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1508844069
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 428
Provider Second Line Business Mailing Address:
1490 E FOREMASTER DR STE 110
Provider Business Mailing Address City Name:
ST GEORGE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-652-4455
Provider Business Mailing Address Fax Number:
435-652-4472

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1490 E FOREMASTER DR
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
ST GEORGE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84790
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-652-4455
Provider Business Practice Location Address Fax Number:
435-652-4472
Provider Enumeration Date:
01/05/2006

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:  5071 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 107008400102 . This is a "IHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0M0000055827 . This is a "ALTIUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 311308 . This is a "DMBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 87726 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 61582 . This is a "PEHP" identifier . This identifiers is of the category "OTHER".