Provider Demographics
NPI:1548985427
Name:JOHNSON, TAYLOR M (DPT)
Entity type:Individual
Prefix:MISS
First Name:TAYLOR
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4351 24TH AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-4506
Mailing Address - Country:US
Mailing Address - Phone:810-385-7405
Mailing Address - Fax:810-385-7420
Practice Address - Street 1:4351 24TH AVE STE 5
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-4506
Practice Address - Country:US
Practice Address - Phone:810-385-7405
Practice Address - Fax:810-385-7420
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501301862208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation