Healthcare Provider Details

I. General information

NPI: 1083949713
Provider Name (Legal Business Name): FRANCIS JOHNSON III L.P.T.A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 OCEAN SPRINGS RD
OCEAN SPRINGS MS
39564-3421
US

IV. Provider business mailing address

3518 SHERLAWN DR # A
MOSS POINT MS
39563-3839
US

V. Phone/Fax

Practice location:
  • Phone: 875-936-3228
  • Fax:
Mailing address:
  • Phone: 337-513-1046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number3352
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number6207
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: