Provider Demographics
NPI:1548766710
Name:HIGHTOWER, JOHNNY WAYNE (PT)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:WAYNE
Last Name:HIGHTOWER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 COUNTY ROAD 316
Mailing Address - Street 2:
Mailing Address - City:CRANE HILL
Mailing Address - State:AL
Mailing Address - Zip Code:35053-4213
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1965 AL HIGHWAY 157
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0672
Practice Address - Country:US
Practice Address - Phone:256-775-2722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH2244225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist