Healthcare Provider Details

I. General information

NPI: 1548490196
Provider Name (Legal Business Name): BENJAMIN JOHN JOHNSON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2009
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 E RIVERSIDE DR STE 204
ST GEORGE UT
84790-5161
US

IV. Provider business mailing address

1062 E RIVERSIDE DR STE 204
ST GEORGE UT
84790-5161
US

V. Phone/Fax

Practice location:
  • Phone: 435-525-1877
  • Fax: 435-215-7665
Mailing address:
  • Phone: 435-525-1877
  • Fax: 435-215-7665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number7365716-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: