Wyatt Lee Johnson, PTA

NPI #1861112161 in Bloomsdale, Missouri

Provider Information

NPI Number: 1861112161
Entity Type: Individual
Name: Wyatt Lee Johnson, PTA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapy Assistant
Credential: PTA
Enumeration Date: Aug 29, 2022
Last Updated: Aug 29, 2022

Practice Location

Address: 490 HIGHWAY 61
City: Bloomsdale
State: Missouri
ZIP Code: 63627-9131
Phone: (573) 483-5040

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapy Assistant	225200000X	Primary

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