Provider Demographics
NPI:1114437829
Name:JOHNSON, TONIA LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:TONIA
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:TONIA
Other - Middle Name:LYNN
Other - Last Name:WITHERITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:OLANTA
Mailing Address - State:PA
Mailing Address - Zip Code:16863-0008
Mailing Address - Country:US
Mailing Address - Phone:814-762-2111
Mailing Address - Fax:
Practice Address - Street 1:100 HIGH POINT DR
Practice Address - Street 2:
Practice Address - City:KANE
Practice Address - State:PA
Practice Address - Zip Code:16735-9704
Practice Address - Country:US
Practice Address - Phone:814-837-6706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-08
Last Update Date:2017-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1000225225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant