Provider Demographics
NPI:1477798635
Name:JOHNSON, CHARISSA L (DPT)
Entity Type:Individual
Prefix:
First Name:CHARISSA
Middle Name:L
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 1:6101 S 56 ST
Mailing Address - Street 2:#1 CROSSROADS PHYSICAL THERAPY
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516
Mailing Address - Country:US
Mailing Address - Phone:402-420-0800
Mailing Address - Fax:402-420-0801
Practice Address - Street 1:6101 S 56 ST
Practice Address - Street 2:#1
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516
Practice Address - Country:US
Practice Address - Phone:402-420-0800
Practice Address - Fax:402-420-0801
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2712225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist