Basic Information
| Provider Information | |||||||||
| NPI: | 1740563972 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNS | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 440 MERCHANT DR | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730696470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058098713 | ||||||||
| FaxNumber: | 4055736768 | ||||||||
| Practice Location | |||||||||
| Address1: | 402 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HENRYETTA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744374242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186520443 | ||||||||
| FaxNumber: | 9186520434 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2011 | ||||||||
| LastUpdateDate: | 10/30/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 4424 | OK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 4424 | 01 | OK | PT LICENSE | OTHER |