Provider Demographics
NPI:1023191558
Name:JOHNSON, LAURA MAUREEN (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MAUREEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4559 LOUISE SAINT CLAIRE DR
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-9055
Mailing Address - Country:US
Mailing Address - Phone:610-999-3562
Mailing Address - Fax:215-794-1944
Practice Address - Street 1:3488 YORK RD
Practice Address - Street 2:
Practice Address - City:FURLONG
Practice Address - State:PA
Practice Address - Zip Code:18925-1227
Practice Address - Country:US
Practice Address - Phone:215-794-1944
Practice Address - Fax:215-794-1944
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA016546225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist