Healthcare Provider Details

I. General information

NPI: 1306882485
Provider Name (Legal Business Name): RAYMOND JOHN JOHNSON P.T. M.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 EASTON RD
ROSLYN PA
19001-2401
US

IV. Provider business mailing address

226 GOODFORD RD
PHILADELPHIA PA
19154-4322
US

V. Phone/Fax

Practice location:
  • Phone: 215-885-2022
  • Fax: 215-885-7408
Mailing address:
  • Phone: 215-612-7992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT008454L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: