Provider Demographics
NPI:1235452749
Name:JOHNSON, LAUREN REBECCA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:REBECCA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 WINDSTONE TRL
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-5733
Mailing Address - Country:US
Mailing Address - Phone:678-438-9386
Mailing Address - Fax:
Practice Address - Street 1:1335 RIDGELAND PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-0728
Practice Address - Country:US
Practice Address - Phone:770-663-6595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009872225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist