Provider Demographics
NPI:1144543869
Name:JOHNSON, TOMMIE E JR
Entity type:Individual
Prefix:
First Name:TOMMIE
Middle Name:E
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 US HIGHWAY 271 N. SUITE A
Mailing Address - Street 2:
Mailing Address - City:GILMER
Mailing Address - State:TX
Mailing Address - Zip Code:75644-4132
Mailing Address - Country:US
Mailing Address - Phone:903-797-2729
Mailing Address - Fax:903-797-2729
Practice Address - Street 1:1420 US HIGHWAY 271 N STE A
Practice Address - Street 2:
Practice Address - City:GILMER
Practice Address - State:TX
Practice Address - Zip Code:75644-4132
Practice Address - Country:US
Practice Address - Phone:903-797-2729
Practice Address - Fax:903-797-2729
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLMT MT108519225100000X, 225400000X, 225700000X, 225800000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist