Individual
MR. PHILLIP W JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
3635 S MAIN ST, SUITE A, BLACKSBURG, VA 24060-7019
(540) 951-2566
(540) 951-7818
Mailing address
3635 S MAIN ST, SUITE A, BLACKSBURG, VA 24060-7019
(540) 951-2566
(540) 951-7818
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
CPO 02395
FL
224P00000X
Prosthetist
CPO 02395
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
175522
ANTHEM BCBS
VA
01
—
5401900001
DMERC MEDICARE
VA
Enumeration date
07/05/2007
Last updated
12/21/2007
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