Provider Demographics
NPI:1871837864
Name:JOHNSON, ROBERT BRANDON (MSPT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BRANDON
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 SWISTRO RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:PA
Mailing Address - Zip Code:18825-9563
Mailing Address - Country:US
Mailing Address - Phone:570-442-1023
Mailing Address - Fax:
Practice Address - Street 1:82 N MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-1914
Practice Address - Country:US
Practice Address - Phone:570-282-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA022143225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist