Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 5765 | OH |
NPI | 1003201948 |
---|---|
Provider Name | Christina Johnson |
First Address | Germantown, OH 45327-8540 |
Second Address | Germantown, OH 45327-8540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2015 |
Last Update Date | 30/03/2015 |