Individual
MR. RANDY SHANE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSPT
Contact information
Practice address
1600 N 2ND ST, CLINTON, MO 64735-1192
(660) 890-7190
Mailing address
1600 N 2ND ST, CLINTON, MO 64735-1192
(660) 890-7190
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2005010779
MO
Other
Enumeration date
11/06/2006
Last updated
07/08/2007
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