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General NPI Number Information
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NPI Number | 1518721943
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Entity Type | Individual
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Provider Name | EVAN JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 02/07/2024
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 3901 S LAMAR BLVD STE 140
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City | AUSTIN
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State | TX
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Zip | 78704-7989
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Country | US
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Telephone | 512-462-3275
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Fax |
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Provider Business Mailing Address
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Address Line | 8800 HIGHWAY 290 W APT 517
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City | AUSTIN
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State | TX
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Zip | 78736-7861
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Country | US
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Telephone | 612-799-4568
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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 |
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License Number State |
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