Provider Demographics
NPI:1154341899
Name:JOHNSON, JAMES (PT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 LA VENTA DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3703
Mailing Address - Country:US
Mailing Address - Phone:805-777-7370
Mailing Address - Fax:805-777-7380
Practice Address - Street 1:110 JENSEN CT
Practice Address - Street 2:SUITE 2C
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-7483
Practice Address - Country:US
Practice Address - Phone:805-413-1070
Practice Address - Fax:805-413-1076
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1043236078OtherWLV GROUP NPI #
CA1558498337OtherTO GROUP NPI #