Provider Demographics
NPI:1578751236
Name:JOHNSON, DEIDRE ANN (PT)
Entity Type:Individual
Prefix:MS
First Name:DEIDRE
Middle Name:ANN
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 1:119 W 23RD ST
Mailing Address - Street 2:#1002
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2427
Mailing Address - Country:US
Mailing Address - Phone:212-675-3447
Mailing Address - Fax:212-243-5213
Practice Address - Street 1:119 W 23RD ST
Practice Address - Street 2:#1002
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2427
Practice Address - Country:US
Practice Address - Phone:212-675-3447
Practice Address - Fax:212-243-5213
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015161225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist