Individual
MR. GARY RUSSELL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
558 1ST SOUTH ST, WOODVILLE, MS 39669-3777
(601) 888-7944
(601) 888-4676
Mailing address
558 1ST SOUTH ST, WOODVILLE, MS 39669-3777
(601) 888-7944
(601) 888-4676
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1639
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00126497
—
MS
Enumeration date
12/11/2006
Last updated
10/22/2007
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