Provider Demographics
NPI:1235236274
Name:JOHNSON, CAROL ANN (PTA)
Entity Type:Individual
Prefix:MISS
First Name:CAROL
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:HARVEGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7411 S 116TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-3054
Mailing Address - Country:US
Mailing Address - Phone:206-697-5452
Mailing Address - Fax:
Practice Address - Street 1:12844 MILITARY RD S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-3045
Practice Address - Country:US
Practice Address - Phone:206-248-4639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant