| Doctor Name: | MATTHEW TRENT JOHANSEN |
| NPI Number: | 1073821088 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | 313728-2401 |
| Business Practice Address: | 652 S. Medical Center Dr. #ll10 St. George, UT - 847907017 |
| Business Phone Number: | 4352512250 |
| Business Fax Number: | |
| Mailing Address: | 652 S. Medical Center Dr. #ll10, ST. GEORGE |
| State: | UT |
| Postal Code: | 847907017 |
| Phone Number: | 4352512250 |
| Fax Number: | |
| NPI Enumeration Date: | 09/24/2010 |
| NPI Last Update Date: | 09/24/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | 313728-2401 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |