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NPI Code Detail

MEDICARE: DEVIN LUCAS JOHNSON DPT

MEDICARE:   DEVIN LUCAS JOHNSON  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
1225100000XPhysical Therapist1314915TX

General Provider Information

NPI Number : 1881159515
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEVIN LUCAS JOHNSON DPT
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12650 N BEACH ST STE 150
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-4243
Country : US
Telephone Number : 817-402-0218
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2019
Last Update Date : 06/04/2024

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Directions to “ DEVIN LUCAS JOHNSON DPT” Practice Location

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