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NPI Code Detail

MEDICARE: MR. RANDALL G JOHNSON PT

MEDICARE: MR. RANDALL G JOHNSON PT
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
1225100000XPhysical TherapistPT00002274WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396747804
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RANDALL G JOHNSON PT
Provider Business Mailing Address
First Line : PO BOX 731269
Second Line :
City : PUYALLUP
State : WA
Zip : 98373-0060
Country : US
Telephone Number : 253-840-2313
Fax Number : 253-840-6340
Provider Business Practice Location Address
First Line : 3912 10TH ST SE
Second Line :
City : PUYALLUP
State : WA
Zip : 98374-2188
Country : US
Telephone Number : 253-848-4700
Fax Number : 253-848-8897
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2005
Last Update Date : 07/08/2007

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Directions to “ MR. RANDALL G JOHNSON PT” Practice Location

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