Provider Demographics
NPI:1346234705
Name:JOHNSON, LEE ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:LEE
Middle Name:ANN
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 1:3325 CHANDLER HWY
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-7648
Mailing Address - Country:US
Mailing Address - Phone:903-596-8999
Mailing Address - Fax:903-531-2248
Practice Address - Street 1:3325 CHANDLER HWY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-7648
Practice Address - Country:US
Practice Address - Phone:903-596-8999
Practice Address - Fax:903-531-2248
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX131987225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist