Provider Demographics
NPI:1164595708
Name:WEBB, JOHNNY LEE (PTA)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:LEE
Last Name:WEBB
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1240
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105
Mailing Address - Country:US
Mailing Address - Phone:606-325-7955
Mailing Address - Fax:606-325-9848
Practice Address - Street 1:2400 13TH STREET
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102
Practice Address - Country:US
Practice Address - Phone:606-329-0910
Practice Address - Fax:606-325-9848
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPTAA01896225200000X
OHPTA05511225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant