Healthcare Provider Details

I. General information

NPI: 1285851659
Provider Name (Legal Business Name): JOHN G JOHNSON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 WALLACE BLVD SUITE E
CINNAMINSON NJ
08077-2578
US

IV. Provider business mailing address

124 SWEDES RUN DR
DELRAN NJ
08075-2116
US

V. Phone/Fax

Practice location:
  • Phone: 856-829-0015
  • Fax: 856-829-0043
Mailing address:
  • Phone: 856-829-0015
  • Fax: 856-829-0043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: