Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251G0304X | Physical Therapist - Geriatrics | 1196679 | TX |
Y | 2251G0304X | Physical Therapist - Geriatrics | 4512 | CO |
NPI | 1073848040 |
---|---|
Provider Name | Ms. Donna Jeane Johnson |
First Address | Waco, TX 76708-2711 |
Second Address | Waco, TX 76704-1711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2009 |
Last Update Date | 17/01/2019 |