Healthcare Provider Details

I. General information

NPI: 1740563972
Provider Name (Legal Business Name): RICHARD J JOHNS II PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 10/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 W MAIN ST
HENRYETTA OK
74437-4242
US

IV. Provider business mailing address

440 MERCHANT DR
NORMAN OK
73069-6470
US

V. Phone/Fax

Practice location:
  • Phone: 918-652-0443
  • Fax: 918-652-0434
Mailing address:
  • Phone: 405-809-8713
  • Fax: 405-573-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4424
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: