Provider Demographics
NPI:1053901983
Name:JOHNSON, ANDREW SCOTT (PTA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:SCOTT
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 FRANKLIN CIR
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-9119
Mailing Address - Country:US
Mailing Address - Phone:828-292-4393
Mailing Address - Fax:
Practice Address - Street 1:240 HOSPITAL DR NE
Practice Address - Street 2:
Practice Address - City:BOLIVIA
Practice Address - State:NC
Practice Address - Zip Code:28422-8346
Practice Address - Country:US
Practice Address - Phone:910-721-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2933225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant