Individual
BEAU Q JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11650
WI
225100000X
Physical Therapist
5231022-2401
UT
Other
Enumeration date
10/19/2006
Last updated
09/15/2020
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