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General NPI Number Information
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NPI Number | 1225537228
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Entity Type | Individual
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Provider Name | LEVI JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 02/05/2018
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 280 1ST ST BLDG 23
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City | HOLLOMAN AFB
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State | NM
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Zip | 88330-8273
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Country | US
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Telephone | 575-572-3564
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Fax |
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Provider Business Mailing Address
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Address Line | 224 ESPANA LN
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City | EL PASO
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State | TX
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Zip | 79912-4512
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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 |
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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 | CP004023T
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1301339
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5867
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License Number State | NM
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