Provider Demographics
NPI:1205029758
Name:JOHNSON, CONNIE COLLINS (PT)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:COLLINS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14516 S HILLS CT
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1353
Mailing Address - Country:US
Mailing Address - Phone:703-830-6354
Mailing Address - Fax:
Practice Address - Street 1:14516 S HILLS CT
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-1353
Practice Address - Country:US
Practice Address - Phone:703-830-6354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-18
Last Update Date:2007-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004645225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist