Provider Demographics
NPI:1568808616
Name:JOHNSON, JENNIFER MARLAND (MSPT)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:MARLAND
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 HERRON ST
Mailing Address - Street 2:
Mailing Address - City:FT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-3126
Mailing Address - Country:US
Mailing Address - Phone:706-861-7471
Mailing Address - Fax:
Practice Address - Street 1:118 HERRON ST
Practice Address - Street 2:
Practice Address - City:FT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-3126
Practice Address - Country:US
Practice Address - Phone:706-861-7471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007414225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist