Provider Demographics
NPI:1215599576
Name:JOHNSON, RHONDA LYNETTE
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:LYNETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12108 BERMUDA CROSSROAD LN STE 21
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-2452
Mailing Address - Country:US
Mailing Address - Phone:804-229-0420
Mailing Address - Fax:
Practice Address - Street 1:12108 BERMUDA CROSSROAD LN STE 21
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-2452
Practice Address - Country:US
Practice Address - Phone:804-229-0420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-07
Last Update Date:2019-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1316461744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty