=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306154125
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRIS JOHNSON PT PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2010
-----------------------------------------------------
Last Update Date | 11/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 NICKERSON ST SUITE 150
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98109-1654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-721-6789
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4501 39TH AVE S
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98118-1617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-721-6789
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. CHRISTOPHER D JOHNSON
-----------------------------------------------------
Credential | MPT, MCMT, ITCA
-----------------------------------------------------
Telephone | 347-433-6789
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 60353079
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------