Provider Demographics
NPI:1083794697
Name:JOHNSON, JOANN M (RPT)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 W MAIN ST
Mailing Address - Street 2:BLDG 2
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708
Mailing Address - Country:US
Mailing Address - Phone:203-755-9355
Mailing Address - Fax:203-597-8192
Practice Address - Street 1:1320 W MAIN ST
Practice Address - Street 2:BLDG 2
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708
Practice Address - Country:US
Practice Address - Phone:203-755-9355
Practice Address - Fax:203-597-8192
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004478225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0024801OtherHEALTH NET ORTHONET
0V1830OtherHEALTH NET
24801OtherCIGNA ORTHONET
004383OtherUS HEALTH CARE
ANC758OtherOXFORD
004383OtherAETNA
CT080004478CT06OtherANTHEM BCBS OF CT
6248766001OtherCIGNA
004383OtherUS HEALTH CARE