Healthcare Provider Details

I. General information

NPI: 1205124294
Provider Name (Legal Business Name): LAUREL B JOHNSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 07/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7608 E 91ST ST
TULSA OK
74133-6014
US

IV. Provider business mailing address

7608 E 91ST ST
TULSA OK
74133-6014
US

V. Phone/Fax

Practice location:
  • Phone: 918-663-0606
  • Fax: 918-663-8754
Mailing address:
  • Phone: 918-663-0606
  • Fax: 918-663-8754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number4475
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: