Individual
GARY WAYNE JOHNSON
Active
Individual
GARY WAYNE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, LMT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
013568
OH
225700000X
Massage Therapist
33.023867
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0779171
—
OH
Enumeration date
02/23/2012
Last updated
03/14/2018
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