Individual
MR. MATTHEW TRUMAN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2860 E 19500 N, MORONI, UT 84646
(435) 436-9029
Mailing address
480 E 100 S, EPHRAIM, UT 84627-5550
(435) 899-1624
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235458555
—
UT
Enumeration date
09/05/2013
Last updated
09/05/2013
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