Individual
MICHAEL P JOHANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
217 W GEORGIA AVENUE, NAMPA, ID 83686
(208) 463-3000
(208) 463-3034
Mailing address
217 W GEORGIA, SUITE 115, NAMPA, ID 83686
(208) 463-3000
(208) 463-3034
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT2163
ID
Other
Enumeration date
03/13/2007
Last updated
07/08/2007
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