Provider Demographics
NPI:1073848040
Name:JOHNSON, DONNA JEANE (PT)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:JEANE
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 1:2501 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-2711
Mailing Address - Country:US
Mailing Address - Phone:254-227-3945
Mailing Address - Fax:
Practice Address - Street 1:1010 DALLAS ST
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76704-1711
Practice Address - Country:US
Practice Address - Phone:254-752-9774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11966792251G0304X
CO45122251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics