Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 40QB00118900 | NJ |
NPI | 1023135423 |
---|---|
Provider Name | Ms. Joann Johnson |
First Address | Little Ferry, NJ 07643-1804 |
Second Address | Englewood, NJ 07631-4356 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 08/07/2007 |