Jacob Johnson

NPI #1164310926 in Oak Creek, Wisconsin

Provider Information

NPI Number: 1164310926
Entity Type: Individual
Name: Jacob Johnson
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physical Therapy Assistant
Enumeration Date: Jun 27, 2025
Last Updated: Jun 27, 2025

Practice Location

Address: 2700 W HONADEL BLVD
City: Oak Creek
State: Wisconsin
ZIP Code: 53154-2650
Phone: (414) 420-2919

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapy Assistant	225200000X	Primary

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