Provider Demographics
NPI:1093743122
Name:JOHNSON, ANANTHI (DPT, COMPT)
Entity Type:Individual
Prefix:MRS
First Name:ANANTHI
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPT, COMPT
Other - Prefix:MRS
Other - First Name:ANANTHI
Other - Middle Name:
Other - Last Name:DHARMASINGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, COMPT
Mailing Address - Street 1:13245 NORTHLINE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-1070
Mailing Address - Country:US
Mailing Address - Phone:734-246-2130
Mailing Address - Fax:734-246-8371
Practice Address - Street 1:13245 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1070
Practice Address - Country:US
Practice Address - Phone:734-246-2130
Practice Address - Fax:734-246-8371
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010908225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist