Individual
MR. HENRY BREAVOID JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
435 E ALLENS LN, PHILADELPHIA, PA 19119-1104
(215) 753-9033
Mailing address
435 E ALLENS LN, PHILADELPHIA, PA 19119-1104
(215) 753-9033
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
OCC003859L
PA
Other
Enumeration date
04/03/2007
Last updated
07/08/2007
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