Provider Demographics
NPI:1518531003
Name:JOHNSON, DAHLIA
Entity Type:Individual
Prefix:
First Name:DAHLIA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 SQUIRE REACH
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-9198
Mailing Address - Country:US
Mailing Address - Phone:757-404-7540
Mailing Address - Fax:
Practice Address - Street 1:162 SQUIRE REACH
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-9198
Practice Address - Country:US
Practice Address - Phone:757-404-7540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00000000208100000X
VA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation