MEDICARE: JOSEPH MICHAEL JOHNSON JR. 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		FL

General Provider Information

NPI Number	:	1639020878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH MICHAEL JOHNSON JR. DPT

Provider Business Mailing Address
First Line	:	2708 TRAILS AT HIDDEN HBR
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-4175
Country	:	US
Telephone Number	:	321-537-5300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2708 TRAILS AT HIDDEN HBR
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-4175
Country	:	US
Telephone Number	:	321-537-5300
Fax Number	:

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

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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