MEDICARE: NAOMI JOHNSON PT, DPT

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	305419	CA

General Provider Information

NPI Number	:	1114797925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAOMI JOHNSON PT, DPT

Provider Business Mailing Address
First Line	:	4206 SORRENTO VALLEY BLVD STE E
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1411
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4206 SORRENTO VALLEY BLVD STE E
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1411
Country	:	US
Telephone Number	:	619-354-7036
Fax Number	:

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

Provider Enumeration Date	:	01/03/2024
Last Update Date	:	01/03/2024

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