Provider Demographics
NPI:1225180847
Name:JOHNSON, MARCELINA ANNETTE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:MARCELINA
Middle Name:ANNETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:MARCE
Other - Middle Name:ANNETTE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPT
Mailing Address - Street 1:2167 QUAIL MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-2621
Mailing Address - Country:US
Mailing Address - Phone:972-342-4210
Mailing Address - Fax:972-797-0691
Practice Address - Street 1:2167 QUAIL MEADOW LN
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-2621
Practice Address - Country:US
Practice Address - Phone:972-342-4210
Practice Address - Fax:972-797-0691
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1215863225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT28759BMedicare ID - Type Unspecified