Provider Demographics
NPI:1437366119
Name:JOHNSON, RHONDA GALE (PTA,ATC)
Entity Type:Individual
Prefix:MISS
First Name:RHONDA
Middle Name:GALE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PTA,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8430 FOREST BREEZE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:TN
Mailing Address - Zip Code:37341
Mailing Address - Country:US
Mailing Address - Phone:423-778-3196
Mailing Address - Fax:423-778-6197
Practice Address - Street 1:8430 FOREST BREEZE DR
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:TN
Practice Address - Zip Code:37341-6951
Practice Address - Country:US
Practice Address - Phone:423-778-3196
Practice Address - Fax:423-778-6197
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000157225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant