Healthcare Provider Details

I. General information

NPI: 1104747211
Provider Name (Legal Business Name): SCOTT WESLEY JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 MALCOM DRIVE STE 200
WESTMINSTER MD
21157
US

IV. Provider business mailing address

303 CRESTVIEW CT
WESTMINSTER MD
21158-4201
US

V. Phone/Fax

Practice location:
  • Phone: 410-751-7930
  • Fax:
Mailing address:
  • Phone: 814-308-3399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA5769
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: