Individual
BRANDON JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
527 MEMORIAL DR, POCATELLO, ID 83201-4063
(208) 226-6964
Mailing address
527 MEMORIAL DR, POCATELLO, ID 83201-4063
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3982
ID
Other
Enumeration date
12/29/2016
Last updated
12/29/2016
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