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General NPI Number Information
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NPI Number | 1720142185
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Entity Type | Individual
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Provider Name | KENNETH RALPH JOHNSON P.T.
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Gender | Male
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 200 MUIR RD HACIENDA BUILDING
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City | MARTINEZ
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State | CA
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Zip | 94553-4614
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Country | US
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Telephone | 925-372-3379
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Fax |
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Provider Business Mailing Address
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Address Line | 2017 ESSEX ST
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City | BERKELEY
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State | CA
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Zip | 94703-2512
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Country | US
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Telephone | 510-845-7131
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 11618
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License Number State | CA
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