Provider Demographics
NPI:1467729798
Name:JOHNSON, KATHRYN ELIZABETH (DPT)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ELIZABETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 W MAIN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-2063
Mailing Address - Country:US
Mailing Address - Phone:440-593-2804
Mailing Address - Fax:440-593-2820
Practice Address - Street 1:348 W MAIN RD
Practice Address - Street 2:SUITE B
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2063
Practice Address - Country:US
Practice Address - Phone:440-593-2804
Practice Address - Fax:440-593-2820
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT13512225100000X
PAPT021354225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist