Individual
MARK JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
3303 SW BOND AVE FL 1, PORTLAND, OR 97239-4501
(503) 494-3151
Mailing address
PO BOX 80792, PORTLAND, OR 97280-5165
(503) 494-3151
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6531
OR
Other
Enumeration date
02/25/2012
Last updated
09/26/2017
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