Provider Demographics
NPI:1912166109
Name:JOHNSON, TRUITT LAMAR (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:TRUITT
Middle Name:LAMAR
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:16420 PERRIS BLVD STE Q
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-1136
Mailing Address - Country:US
Mailing Address - Phone:951-571-2450
Mailing Address - Fax:951-571-2455
Practice Address - Street 1:16420 PERRIS BLVD STE Q
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551-1136
Practice Address - Country:US
Practice Address - Phone:951-571-2450
Practice Address - Fax:951-571-2455
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 26033225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist