Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 006326 | KY |
NPI | 1003246836 |
---|---|
Provider Name | Cara Johnson |
First Address | Lexington, KY 40513-1770 |
Second Address | Lexington, KY 40513-1770 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2013 |
Last Update Date | 14/11/2013 |