Individual
CALYN NICOLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.A.
Contact information
Practice address
1200 E PECAN ST, ALTUS, OK 73521-6141
(580) 379-5820
(580) 379-5829
Mailing address
14425 N 2320 RD, GOTEBO, OK 73041-6708
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2667
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201092420A
—
OK
Enumeration date
11/01/2016
Last updated
10/06/2022
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