Individual
BRAD DAVID JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
12201 RENFERT WAY, SUITE 115, AUSTIN, TX 78758-5354
(512) 551-0375
Mailing address
4837 TRAIL CREST CIR, AUSTIN, TX 78735-6345
(512) 952-0844
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1132629
TX PROFESSIONAL LICENSE
TX
Enumeration date
08/29/2006
Last updated
05/13/2015
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