Individual
MR. CARL AUSTIN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
285 W FRANCIS, BLACKFOOT PHYSICAL THERAPY, BLACKFOOT, ID 83221
(208) 785-0123
(208) 782-1885
Mailing address
5112 LINDEE LANE, IDAHO FALLS, ID 83406
(208) 523-4815
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT944
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T4629
BLUE CROSS
ID
Enumeration date
12/28/2006
Last updated
07/08/2007
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