Healthcare Provider Details

I. General information

NPI: 1306377288
Provider Name (Legal Business Name): MATTHEW TYLER JOHNSON PT, DPT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 HOSPITAL CENTER BLVD STE 250
HILTON HEAD ISLAND SC
29926-8702
US

IV. Provider business mailing address

1300 W SAM HOUSTON PKWY S STE 300
HOUSTON TX
77042-2453
US

V. Phone/Fax

Practice location:
  • Phone: 843-671-7342
  • Fax: 843-671-7343
Mailing address:
  • Phone: 843-671-7342
  • Fax: 843-671-7343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT030634
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP050296T
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP060058T
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: