Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA1272 | AR |
NPI | 1003434200 |
---|---|
Provider Name | Angela Maria Johnson |
First Address | Little Rock, AR 72212-3903 |
Second Address | Little Rock, AR 72212-3903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2020 |
Last Update Date | 14/07/2020 |