Provider Demographics
NPI:1083125892
Name:JOHNSON THERAPY SERVICES
Entity Type:Organization
Organization Name:JOHNSON THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL AND PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RACINE
Authorized Official - Middle Name:EUGENIA
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, DPT
Authorized Official - Phone:704-808-0992
Mailing Address - Street 1:10216 PERIMETER PKWY # 9
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-2461
Mailing Address - Country:US
Mailing Address - Phone:704-808-0992
Mailing Address - Fax:
Practice Address - Street 1:10216 PERIMETER PKWY # 9
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-2461
Practice Address - Country:US
Practice Address - Phone:704-808-0992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 225X00000X, 235Z00000X
NC6889261QH0100X
NC11610261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty