Individual
MR. DEVIN J JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
03097
IA
2251G0304X
Geriatric Physical Therapist
03097
IA
2251S0007X
Sports Physical Therapist
03097
IA
2251X0800X
Orthopedic Physical Therapist
03097
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34706
BLUE CROSS BLUE SHEILD
IA
01
—
36G94JO
BLUE CROSS BLUE SHEILD
MN
01
—
421470451
MAYO
IA
Enumeration date
06/12/2006
Last updated
04/03/2018
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