Provider Demographics
NPI:1073552113
Name:JOHNSON, HEATHER E (PT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:E
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 1:23 ELLIOTT ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03064-6215
Mailing Address - Country:US
Mailing Address - Phone:603-223-2300
Mailing Address - Fax:603-228-9739
Practice Address - Street 1:1 PILLSBURY ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3556
Practice Address - Country:US
Practice Address - Phone:603-223-2300
Practice Address - Fax:603-228-9730
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist