Individual
GREG L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, BPS, PTA
Contact information
Practice address
305 E MIEL DE LUNA AVE, TUCUMCARI, NM 88401-3810
(575) 461-7230
Mailing address
4201B QUAY ROAD 66, TUCUMCARI, NM 88401-9524
(615) 618-2057
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A-0767
NM
Other
Enumeration date
08/23/2012
Last updated
08/23/2012
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