Provider Demographics
NPI:1114525441
Name:JOHNSON, SHARON EVETTE (PHYSICAL THERAPY)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:EVETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WHITE MARSH PARK DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-4361
Mailing Address - Country:US
Mailing Address - Phone:301-906-6455
Mailing Address - Fax:
Practice Address - Street 1:9470 ANNAPOLIS RD STE 416
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3000
Practice Address - Country:US
Practice Address - Phone:240-770-3505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17534225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist