Provider Demographics
NPI:1568945038
Name:JOHNSON, KIMBERLAND TAYLOR (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLAND
Middle Name:TAYLOR
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 JONES RD
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:TX
Mailing Address - Zip Code:75839-7605
Mailing Address - Country:US
Mailing Address - Phone:903-764-2291
Mailing Address - Fax:
Practice Address - Street 1:214 JONES RD
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:TX
Practice Address - Zip Code:75839-7605
Practice Address - Country:US
Practice Address - Phone:903-764-2291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2065259225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant