Provider Demographics
NPI:1508942962
Name:JOHNSON, RENEE STONE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:STONE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 EAGLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37166
Mailing Address - Country:US
Mailing Address - Phone:615-597-4269
Mailing Address - Fax:931-506-5065
Practice Address - Street 1:203 OAK PARK DR
Practice Address - Street 2:NHC REHAB
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110
Practice Address - Country:US
Practice Address - Phone:931-473-6039
Practice Address - Fax:931-506-5065
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000002567225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant