Healthcare Provider Details

I. General information

NPI: 1477814143
Provider Name (Legal Business Name): AMANDA DAWN JOHNSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 4TH AVE N
GREAT FALLS MT
59401-1416
US

IV. Provider business mailing address

1324 4TH AVE N STE A
GREAT FALLS MT
59401-1416
US

V. Phone/Fax

Practice location:
  • Phone: 406-868-0638
  • Fax:
Mailing address:
  • Phone: 406-868-0638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberCP060308T
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0016648
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberCP060307T
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberCP059720T
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: