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General NPI Number Information
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NPI Number | 1407308935
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Entity Type | Individual
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Provider Name | CALYN NICOLE JOHNSON P.T.A.
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Gender | Female
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Dates
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Enumeration Date | 11/01/2016
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Last Update Date | 10/06/2022
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Provider Practice Location Address
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Address Line | 1200 E PECAN ST
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City | ALTUS
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State | OK
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Zip | 73521-6141
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Country | US
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Telephone | 580-379-5820
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Fax | 580-379-5829
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Provider Business Mailing Address
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Address Line | 14425 N 2320 RD
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City | GOTEBO
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State | OK
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Zip | 73041-6708
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2667
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License Number State | OK
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