Provider Demographics
NPI:1083712863
Name:JOHNSON, DEBBIE SUE (PTA)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:SUE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:ROSSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30741-2059
Mailing Address - Country:US
Mailing Address - Phone:706-861-6971
Mailing Address - Fax:
Practice Address - Street 1:2700 PARKWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1730
Practice Address - Country:US
Practice Address - Phone:423-624-1533
Practice Address - Fax:423-242-7103
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN155225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant