Healthcare Provider Details

I. General information

NPI: 1316087281
Provider Name (Legal Business Name): JOHNA CRULL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 WILBUR AVE STE 320
TARZANA CA
91356-1311
US

IV. Provider business mailing address

1650 LYNDON FARM CT STE 300
LOUISVILLE KY
40223-5005
US

V. Phone/Fax

Practice location:
  • Phone: 818-996-1725
  • Fax: 818-996-0210
Mailing address:
  • Phone: 951-335-9825
  • Fax: 951-666-5096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT0006639
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number292707
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: