Provider Demographics
NPI:1104937457
Name:JOHNSON, JOCELYN RODRIGUEZ (PT)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:RODRIGUEZ
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JOCELYN
Other - Middle Name:RODRIGUEZ
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:625 KENMOOR AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2395
Mailing Address - Country:US
Mailing Address - Phone:616-356-5000
Mailing Address - Fax:616-356-5001
Practice Address - Street 1:1651 BOTELHO DR STE 150
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5068
Practice Address - Country:US
Practice Address - Phone:925-386-5657
Practice Address - Fax:888-461-7920
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27479225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist