Basic Information
| Provider Information | |||||||||
| NPI: | 1932580016 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | RUPERT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 870 | ||||||||
| Address2: | |||||||||
| City: | HUNTINGDON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166520870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8773126576 | ||||||||
| FaxNumber: | 8145068213 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 PINE ST | ||||||||
| Address2: | |||||||||
| City: | RENOVO | ||||||||
| State: | PA | ||||||||
| PostalCode: | 177641624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5709231000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2015 | ||||||||
| LastUpdateDate: | 06/14/2015 | ||||||||
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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 | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.