Basic Information
| Provider Information | |||||||||
| NPI: | 1417108762 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | DARREN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1188 106TH AVE NE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980048614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254552630 | ||||||||
| FaxNumber: | 4254514390 | ||||||||
| Practice Location | |||||||||
| Address1: | 1188 106TH AVE NE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980048614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254552630 | ||||||||
| FaxNumber: | 4254514390 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2008 | ||||||||
| LastUpdateDate: | 06/14/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 62-025598 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 2251S0007X | 62-025598 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports | 225100000X | PT60353079 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.