Provider Demographics
NPI:1457486953
Name:JOHNSON, KATHARINE LACKMAN (PT)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:LACKMAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:LOUISE
Other - Last Name:LACKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1801 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-3705
Mailing Address - Country:US
Mailing Address - Phone:215-658-0959
Mailing Address - Fax:215-658-0959
Practice Address - Street 1:705 N SHADY RETREAT RD
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-2507
Practice Address - Country:US
Practice Address - Phone:800-770-4822
Practice Address - Fax:215-658-0959
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT001220E2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics