Individual
MR. WAYNE MICHAEL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA, CCI
Contact information
Practice address
11050 MT BELVEDERE BLVD, USA MEDDAC /CREDENTIALS, FORT DRUM, NY 13602-5004
(315) 772-4025
(315) 772-9498
Mailing address
11050 MT BELVEDERE BLVD, USA MEDDAC / CREDENTIALS, FORT DRUM, NY 13602-5004
(315) 772-4025
(315) 772-9498
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
004281
NY
Other
Enumeration date
08/03/2006
Last updated
07/08/2007
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