Doctor Name: | MR. GARY RUSSELL JOHNSON |
NPI Number: | 1285794107 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PT |
License Number: | PT1639 |
Business Practice Address: | 558 1st South St Woodville, MS - 396693777 |
Business Phone Number: | 6018887944 |
Business Fax Number: | 6018884676 |
Mailing Address: | 558 1st South St, WOODVILLE |
State: | MS |
Postal Code: | 396693777 |
Phone Number: | 6018887944 |
Fax Number: | 6018884676 |
NPI Enumeration Date: | 12/11/2006 |
NPI Last Update Date: | 10/22/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | PT1639 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |