Healthcare Provider Details

I. General information

NPI: 1225444698
Provider Name (Legal Business Name): JOSHUA JOHNSON PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 ROBINWOOD RD
GASTONIA NC
28054-1693
US

IV. Provider business mailing address

1351 ROBINWOOD RD
GASTONIA NC
28054-1693
US

V. Phone/Fax

Practice location:
  • Phone: 704-867-2319
  • Fax:
Mailing address:
  • Phone: 704-867-2319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP10306
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: