Provider Demographics
NPI:1487651659
Name:JOHNSEN, SARAH (PT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:JOHNSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 LINDSEY LN
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-1635
Mailing Address - Country:US
Mailing Address - Phone:912-510-6104
Mailing Address - Fax:912-882-6137
Practice Address - Street 1:100 LINDSEY LN
Practice Address - Street 2:B
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6850
Practice Address - Country:US
Practice Address - Phone:912-510-6104
Practice Address - Fax:912-882-6137
Is Sole Proprietor?:No
Enumeration Date:2005-07-04
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006676225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000967194FMedicaid
FL887932000Medicaid