Provider Demographics
NPI:1558403667
Name:JOHNSON, KAREN A (PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:JOHNSON
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:PO BOX 874
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-0874
Mailing Address - Country:US
Mailing Address - Phone:410-740-2155
Mailing Address - Fax:
Practice Address - Street 1:9159 RED BRANCH RD # F
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2013
Practice Address - Country:US
Practice Address - Phone:410-740-2155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19738225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLS82OtherBLUECROSSBLUESHIEL
MDLS82OtherBLUECROSSBLUESHIEL