Individual
MR. BRADLEY T JOHNSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
929 E MONTCLAIR, SUITE 104, SPRINGFIELD, MO 65807
(417) 888-0808
(417) 888-0811
Mailing address
929 E MONTCLAIR, SUITE 104, SPRINGFIELD, MO 65807
(417) 888-0808
(417) 888-0811
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
R1012
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
169735
BCBS
MO
01
—
P00011829
RAILROAD MEDICARE
MO
Enumeration date
05/10/2006
Last updated
07/08/2007
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