Individual
MR. CARL ANDREW JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
420 MOODY ST, FAIRFIELD, TX 75840-3036
(937) 679-6675
Mailing address
405 MOODY ST, FAIRFIELD, TX 75840-3037
(937) 679-6675
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2099140
TX
Other
Enumeration date
09/05/2018
Last updated
09/05/2018
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