Provider Demographics
NPI:1447560685
Name:JOHNSON, JENNIFER JEAN (PT, MA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JEAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 E OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-4651
Mailing Address - Country:US
Mailing Address - Phone:215-348-4002
Mailing Address - Fax:215-348-4910
Practice Address - Street 1:54 E OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-4651
Practice Address - Country:US
Practice Address - Phone:215-348-4002
Practice Address - Fax:215-348-4910
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020901207PE0004X, 207PS0010X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine