Provider Demographics
NPI:1275856023
Name:JOHNSON, ABIGAIL D (PT)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 DOVE ST STE 242
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2411
Mailing Address - Country:US
Mailing Address - Phone:949-222-6444
Mailing Address - Fax:
Practice Address - Street 1:1601 DOVE ST STE 242
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2411
Practice Address - Country:US
Practice Address - Phone:949-222-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT36510225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist