Healthcare Provider Details

I. General information

NPI: 1962589036
Provider Name (Legal Business Name): RON JOHNSON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5205 JOHN STOCKBAUER DR
VICTORIA TX
77904-1866
US

IV. Provider business mailing address

204 N AVE G
SHINER TX
77984-7121
US

V. Phone/Fax

Practice location:
  • Phone: 361-572-4246
  • Fax: 361-572-9490
Mailing address:
  • Phone: 361-594-8480
  • Fax: 361-594-2527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: