MEDICARE: TREVOR SCOTT JOHNSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1407061	TX
2	225100000X	Physical Therapist	CP048681T	SC
3	225100000X	Physical Therapist	PT44220	FL

General Provider Information

NPI Number	:	1013807106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREVOR SCOTT JOHNSON

Provider Business Mailing Address
First Line	:	4701 REDBUD DR
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76208-6845
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 VILLAGE CENTER BLVD STE 200
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-6706
Country	:	US
Telephone Number	:	843-712-7023
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2025
Last Update Date	:	01/08/2026

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Directions to “ TREVOR SCOTT JOHNSON ” Practice Location

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