Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1558387233 |
---|---|
Provider Name | Ms. Wanda Anita Johnson |
First Address | Memphis, TN 38104-2127 |
Second Address | Memphis, TN 38104-2127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 08/07/2007 |