Provider Demographics
NPI:1407158009
Name:JOHNSON, EILEEN MARY (DPT, PT)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:MARY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:MARY
Other - Last Name:SPANGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:8434 CORCORAN RD
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60480-1666
Mailing Address - Country:US
Mailing Address - Phone:708-467-0657
Mailing Address - Fax:
Practice Address - Street 1:8434 CORCORAN RD
Practice Address - Street 2:
Practice Address - City:WILLOW SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60480-1666
Practice Address - Country:US
Practice Address - Phone:708-467-0657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.018068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist