Provider Demographics
NPI:1700766623
Name:JOHNSON, BRANDIS L (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRANDIS
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:X
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MARTER AVE STE 504
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3120
Mailing Address - Country:US
Mailing Address - Phone:856-642-6580
Mailing Address - Fax:
Practice Address - Street 1:110 MARTER AVE STE 504
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3120
Practice Address - Country:US
Practice Address - Phone:856-642-6580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist