Individual
GERALD R JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICAL THERAPIST
Contact information
Practice address
1300 EGG HARBOR RD STE 108, STURGEON BAY, WI 54235-1284
(920) 746-0410
Mailing address
323 S 18TH AVE, STURGEON BAY, WI 54235-1401
(920) 743-5566
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40239300
—
WI
Enumeration date
08/25/2006
Last updated
07/08/2007
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