| Doctor Name: | MR. ROBERT STANLEY JOHANNSEN |
| NPI Number: | 1033183223 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT, CSCS |
| License Number: | 070-006904 |
| Business Practice Address: | 103 N Main St Port Byron, IL - 612757705 |
| Business Phone Number: | 3095232949 |
| Business Fax Number: | 8017208695 |
| Mailing Address: | 103 North Main Street, P.o. Box 125 PORT BYRON |
| State: | IL |
| Postal Code: | 61275 |
| Phone Number: | 3095232949 |
| Fax Number: | 8017208695 |
| NPI Enumeration Date: | 02/14/2006 |
| NPI Last Update Date: | 07/19/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | 070-006904 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |