Provider Demographics
NPI:1497197529
Name:JOHNSON, ADRIANNA BETH (PT)
Entity Type:Individual
Prefix:
First Name:ADRIANNA
Middle Name:BETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ADRIANNA
Other - Middle Name:B
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MS
Mailing Address - Zip Code:38843-0188
Mailing Address - Country:US
Mailing Address - Phone:662-862-3070
Mailing Address - Fax:662-862-4970
Practice Address - Street 1:950 E COUNTY LINE RD STE A
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1928
Practice Address - Country:US
Practice Address - Phone:601-487-6088
Practice Address - Fax:601-487-6068
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT2722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist