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General NPI Number Information
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NPI Number | 1639750326
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Entity Type | Individual
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Provider Name | DANE GEORGE JOHNSON DPT
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Gender | Male
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Dates
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Enumeration Date | 04/15/2021
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Last Update Date | 04/15/2021
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Provider Practice Location Address
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Address Line | 400 N MOUNTAIN AVE STE 310
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City | UPLAND
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State | CA
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Zip | 91786-5182
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Country | US
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Telephone | 909-920-6457
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Fax |
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Provider Business Mailing Address
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Address Line | 11068 SHILOH CT
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91737-7810
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Country | US
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Telephone | 909-767-2843
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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 | CA
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