Provider Demographics
NPI:1518068774
Name:JOHNSON, LOREN L (PT)
Entity type:Individual
Prefix:
First Name:LOREN
Middle Name:L
Last Name:JOHNSON
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 1:328 S STILLAGUAMISH AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223
Mailing Address - Country:US
Mailing Address - Phone:360-474-8686
Mailing Address - Fax:360-474-0246
Practice Address - Street 1:328 S STILLAGUAMISH AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223
Practice Address - Country:US
Practice Address - Phone:360-474-8686
Practice Address - Fax:360-474-0246
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00000816225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7114713Medicaid
WA8322794Medicaid
WA0167362OtherL&I
WA8322794Medicaid
WA0167362OtherL&I
WAAB36233Medicare ID - Type Unspecified