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General NPI Number Information
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NPI Number | 1235045592
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Entity Type | Individual
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Provider Name | WESLEY JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 08/19/2026
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Last Update Date | 08/19/2026
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Provider Practice Location Address
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Address Line | 2307 BERLIN TPKE
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City | NEWINGTON
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State | CT
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Zip | 06111-3206
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Country | US
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Telephone | 860-687-9700
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Fax | 860-422-4632
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Provider Business Mailing Address
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Address Line | 2307 BERLIN TPKE UNIT 14
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City | NEWINGTON
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State | CT
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Zip | 06111-3206
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Country | US
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Telephone | 860-687-9700
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Fax | 860-422-4632
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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 | 15638
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License Number State | CT
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