Individual
JERRY MICHAEL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1111 W WELLESLEY AVE, FOUR SEASONS PHYSICAL THERAPY, SPOKANE, WA 99205-1274
(509) 327-1578
(509) 327-1596
Mailing address
1111 W WELLESLEY AVE, SPOKANE, WA 99205-1274
(509) 327-1578
(509) 327-1596
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00000931
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7025307
—
WA
05
—
8345829
—
WA
Enumeration date
12/06/2005
Last updated
09/27/2010
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