Provider Demographics
NPI:1275517732
Name:JOHNSON, ANGELIA HIGHTOWER (MSPT)
Entity Type:Individual
Prefix:MS
First Name:ANGELIA
Middle Name:HIGHTOWER
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6270A N UCHEE RD
Mailing Address - Street 2:
Mailing Address - City:HATCHECHUBBEE
Mailing Address - State:AL
Mailing Address - Zip Code:36858-2808
Mailing Address - Country:US
Mailing Address - Phone:334-448-3900
Mailing Address - Fax:334-298-6086
Practice Address - Street 1:1321 9TH AVE
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-5027
Practice Address - Country:US
Practice Address - Phone:334-448-3900
Practice Address - Fax:334-298-6086
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH 4300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALQ09022Medicare UPIN