Individual
BLAIR JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
202 LINCOLNWAY E STE 100, MISHAWAKA, IN 46544-2079
(574) 647-2560
(574) 647-2563
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-3725
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
36000299A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201284010
—
IN
Enumeration date
03/26/2015
Last updated
03/20/2026
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