Provider Demographics
NPI:1326273061
Name:JOHNSON, ANNIE BAKER (LPTA)
Entity Type:Individual
Prefix:MS
First Name:ANNIE
Middle Name:BAKER
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:NC
Mailing Address - Zip Code:27842-0344
Mailing Address - Country:US
Mailing Address - Phone:252-537-9167
Mailing Address - Fax:
Practice Address - Street 1:808 RIVER ROAD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:NC
Practice Address - Zip Code:27842-0344
Practice Address - Country:US
Practice Address - Phone:252-537-9167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1263225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant