Provider Demographics
NPI:1356800163
Name:PATTI JOHNSON PHYSICAL THERAPY & WELLNESS
Entity type:Organization
Organization Name:PATTI JOHNSON PHYSICAL THERAPY & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:661-537-3663
Mailing Address - Street 1:742 S HIGHWAY 66
Mailing Address - Street 2:
Mailing Address - City:MORGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-9555
Mailing Address - Country:US
Mailing Address - Phone:661-537-3663
Mailing Address - Fax:
Practice Address - Street 1:742 S HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:MORGAN
Practice Address - State:UT
Practice Address - Zip Code:84050-9555
Practice Address - Country:US
Practice Address - Phone:661-537-3663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy