Provider Demographics
NPI:1154817641
Name:JOHNSON, TAMMIE KELLER (PT, DPT, MS, ATP)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:KELLER
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT, DPT, MS, ATP
Other - Prefix:
Other - First Name:TAMMIE
Other - Middle Name:LYNN
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:255 E BONITA AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-1933
Mailing Address - Country:US
Mailing Address - Phone:909-596-7733
Mailing Address - Fax:
Practice Address - Street 1:255 E BONITA AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1923
Practice Address - Country:US
Practice Address - Phone:714-642-3687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-08
Last Update Date:2018-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology