Provider Demographics
NPI:1861612004
Name:JOHNSON, DAVID NATHAN (PT, ECS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:NATHAN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PT, ECS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1803
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84059-1803
Mailing Address - Country:US
Mailing Address - Phone:801-367-5204
Mailing Address - Fax:
Practice Address - Street 1:52 N 1100 E
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2952
Practice Address - Country:US
Practice Address - Phone:801-465-6911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT367745-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT198045OtherALTIUS PROVIER NUMBER