Individual
MR. JACOB DARRELL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1515 NORTH CENTER STREET, SUITE 5, LONOKE, AR 72086
(501) 676-5540
(501) 676-6499
Mailing address
1515 NORTH CENTER STREET, SUITE 5, LONOKE, AR 72086
(501) 676-5540
(501) 676-6499
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 3506
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127083742
—
AR
Enumeration date
09/11/2012
Last updated
09/11/2012
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