Provider Demographics
NPI:1427033133
Name:JOHNSON, LINDA B (PT)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:B
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:B
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8808 BRADBURY CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-3038
Mailing Address - Country:US
Mailing Address - Phone:916-685-6694
Mailing Address - Fax:
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-6716
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10828225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist