Provider Demographics
NPI:1265982771
Name:JOHNSON, DANIEL (PT, DPT, PRPC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PT, DPT, PRPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 N MAIN ST STE 75
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1106
Mailing Address - Country:US
Mailing Address - Phone:801-204-9204
Mailing Address - Fax:801-682-4853
Practice Address - Street 1:330 N MAIN ST STE 75
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1106
Practice Address - Country:US
Practice Address - Phone:801-204-9204
Practice Address - Fax:801-682-4853
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6312225100000X
UT11680864-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist