Provider Demographics
NPI:1184840936
Name:JOHNSON, CHRISTINE Q (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:Q
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4631 WHITMAN LN SE
Mailing Address - Street 2:STE D
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513-2250
Mailing Address - Country:US
Mailing Address - Phone:360-458-2444
Mailing Address - Fax:360-458-2747
Practice Address - Street 1:417 W YELM AVE
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-7679
Practice Address - Country:US
Practice Address - Phone:360-458-2444
Practice Address - Fax:360-458-2747
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009980225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0239385OtherDEPT L&I
WA1651QUOtherREGENCE
WA5210QUOtherREGENCE
WA3600QQUOtherREGENCE
WA8522641OtherDSHS
WA7085QUOtherREGENCE
WA6981QUOtherREGENCE
WA5210QUOtherREGENCE