Individual
MITCHELL TROY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
2002 W SUNSET DR, SUITE NUMBER 1, RIVERTON, WY 82501-2283
(307) 856-7021
(307) 856-5546
Mailing address
2002 W SUNSET DR, SUITE NUMBER 1, RIVERTON, WY 82501-2283
(307) 856-7021
(307) 856-5546
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1207
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
315547
BLUE CROSS BLUE SHIELD
WY
Enumeration date
06/29/2006
Last updated
11/15/2007
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