1841618527 NPI number — MICHELLE C JOHNSON DPT

Table of content: MICHELLE C JOHNSON DPT (NPI 1841618527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841618527 NPI number — MICHELLE C JOHNSON DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
MICHELLE
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841618527
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3830 PARK AVE
Provider Second Line Business Mailing Address:
STE 202
Provider Business Mailing Address City Name:
EDISON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08820-2562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-494-0895
Provider Business Mailing Address Fax Number:
732-494-0896

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3830 PARK AVE
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
EDISON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08820-2562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-494-0895
Provider Business Practice Location Address Fax Number:
732-494-0896
Provider Enumeration Date:
03/31/2014

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:  40QA01540600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 40QA01540600 . This is a "STATE OF NEW JERSEY BOARD OF PHYSICAL THERAPY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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