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General NPI Number Information
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NPI Number | 1639660939
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Entity Type | Individual
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Provider Name | CHASE ETHAN JOHNSON PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 1301 SUMMER LEE DR
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City | ROCKWALL
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State | TX
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Zip | 75032-5452
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Country | US
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Telephone | 214-771-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 1113 HIGHGATE RD
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City | FORNEY
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State | TX
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Zip | 75126-3825
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Country | US
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Telephone | 214-799-7639
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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 | 1304538
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License Number State | TX
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