Provider Demographics
NPI:1225048093
Name:JOHNSON, JERRI L (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JERRI
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:JERRI
Other - Middle Name:L
Other - Last Name:QUESENBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2441 N 9TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-3989
Mailing Address - Country:US
Mailing Address - Phone:850-416-7656
Mailing Address - Fax:850-416-6710
Practice Address - Street 1:5150 BAYOU BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2158
Practice Address - Country:US
Practice Address - Phone:850-416-6710
Practice Address - Fax:850-416-6710
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20495222Q00000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811308400Medicaid
FL888000000Medicaid