Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Grover Cleveland Johnson IV

Individual provider Physical Therapy Assistant · NPI 1023759206

Grover Cleveland Johnson IV is a Physical Therapy Assistant in Jefferson City, Missouri. Licensed in Missouri. Registered with an NPI since 2022.

Licensed in
MO
In the registry since
2022

Practice location Address checks out

3600 Country Club Dr Ste 530A
Jefferson City, MO 65109-1060
Phone: (573) 606-7100
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence 2018037368 (MO)

Record details

NPI number1023759206
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedApril 5, 2022
Last updated in NPPESApril 5, 2022
Certification dateMarch 30, 2022

Other providers in Jefferson City