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General NPI Number Information
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NPI Number | 1003767443
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Entity Type | Individual
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Provider Name | NYCKOLAS JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 02/03/2026
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 708 PEMBROKE RD
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City | GREENSBORO
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State | NC
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Zip | 27408-7610
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Country | US
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Telephone | 919-791-6678
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Fax | 919-981-9766
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Provider Business Mailing Address
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Address Line | 1714 CANTERBURY RD
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City | RALEIGH
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State | NC
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Zip | 27608-1110
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Country | US
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Telephone | 919-791-6678
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Fax | 919-981-9766
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | XP1256467
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License Number State | NC
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