Provider Demographics
NPI:1497315535
Name:JOHNSON SEYENKULO, APU AMANDA (DPT)
Entity Type:Individual
Prefix:DR
First Name:APU
Middle Name:AMANDA
Last Name:JOHNSON SEYENKULO
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 1:2406 CROSS POINT CIR APT 12
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-8407
Mailing Address - Country:US
Mailing Address - Phone:773-910-4049
Mailing Address - Fax:
Practice Address - Street 1:3700 TAYLOR GLEN LN NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-3400
Practice Address - Country:US
Practice Address - Phone:704-788-6510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18594225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist