Provider Demographics
NPI:1962589036
Name:JOHNSON, RON (PT)
Entity type:Individual
Prefix:
First Name:RON
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 1:204 N AVE G
Mailing Address - Street 2:
Mailing Address - City:SHINER
Mailing Address - State:TX
Mailing Address - Zip Code:77984-7121
Mailing Address - Country:US
Mailing Address - Phone:361-594-8480
Mailing Address - Fax:361-594-2527
Practice Address - Street 1:5205 JOHN STOCKBAUER DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1866
Practice Address - Country:US
Practice Address - Phone:361-572-4246
Practice Address - Fax:361-572-9490
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist