Individual
LYNN R JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT; LAT
Contact information
Practice address
1611 N WHITLEY DR STE 1A, FRUITLAND, ID 83619-2180
(208) 452-0021
(208) 452-0019
Mailing address
1560 S CAROL ST, MERIDIAN, ID 83646-1839
(208) 571-6739
(208) 452-0019
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT178
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010025680
BLUE SHIELD PIN
ID
01
—
T4884
BLUE CROSS PIN
ID
Enumeration date
08/04/2005
Last updated
03/07/2013
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