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General NPI Number Information
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NPI Number | 1053744458
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Entity Type | Organization
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Legal Business Name | JOHNSON REHABILITATION AND SPORTS PERFORMANCE
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Dates
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Enumeration Date | 08/21/2013
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Last Update Date | 08/21/2013
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Provider Practice Location Address
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Address Line | 312 NORTH OAKLAND AVENUE
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City | OAKLAND
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State | NE
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Zip | 68045
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Country | US
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Telephone | 402-380-1479
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 101
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City | OAKLAND
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State | NE
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Zip | 68045-0101
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | CHRISTOPHER J JOHNSON
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Credential | DPT
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Telephone | 402-380-1479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 3060
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License Number State | NE
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