Individual
KENNETH D JOHNSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
7620 SOUTHERN BLVD, SUITE 3, BOARDMAN, OH 44512-5667
(330) 965-9330
(330) 965-9308
Mailing address
7620 SOUTHERN BLVD, SUITE 3, BOARDMAN, OH 44512-5667
(330) 965-9330
(330) 965-9308
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2011
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT2011
PHYSICAL THERAPY
OH
Enumeration date
09/07/2010
Last updated
08/06/2014
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