Provider Demographics
NPI:1487143590
Name:JOHNSON, JEREMIAH ROGER (PT, DPT, ATC)
Entity type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:ROGER
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14310 GRANT ST APT 13-308
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80023-6457
Mailing Address - Country:US
Mailing Address - Phone:320-760-5866
Mailing Address - Fax:
Practice Address - Street 1:12207 PECOS ST STE 600
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-3896
Practice Address - Country:US
Practice Address - Phone:303-561-0447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer