Healthcare Provider Details

I. General information

NPI: 1780793836
Provider Name (Legal Business Name): JAMES TOBY JOHNSON RKT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 VETERANS MEMORIAL DRIVE OLIN E TEAGUE MEDICAL CENTER
TEMPLE TX
76504
US

IV. Provider business mailing address

5514 LEGACY OAKS DR
TEMPLE TX
76502-7927
US

V. Phone/Fax

Practice location:
  • Phone: 254-743-1931
  • Fax:
Mailing address:
  • Phone: 254-760-1472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number1423
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: