Provider Demographics
NPI:1134461494
Name:JOHNSON, MICHELLE ANNE (DPT)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-3127
Mailing Address - Country:US
Mailing Address - Phone:580-205-2035
Mailing Address - Fax:580-205-2038
Practice Address - Street 1:1011 TEXAS ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-3127
Practice Address - Country:US
Practice Address - Phone:580-205-2035
Practice Address - Fax:580-205-2038
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist