Provider Demographics
NPI:1588654248
Name:JOHNSON-ALLEN, CATHRYN D (LPT)
Entity Type:Individual
Prefix:
First Name:CATHRYN
Middle Name:D
Last Name:JOHNSON-ALLEN
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:CATHRYN
Other - Middle Name:D
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPT
Mailing Address - Street 1:4780 N JOSEY LN
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4615
Mailing Address - Country:US
Mailing Address - Phone:972-492-1334
Mailing Address - Fax:972-395-2294
Practice Address - Street 1:4780 N JOSEY LN
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4615
Practice Address - Country:US
Practice Address - Phone:972-492-1334
Practice Address - Fax:972-395-2294
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX127415225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127415OtherSTATE BOARD
TX127415OtherSTATE BOARD
8K0242Medicare PIN
TXB156564Medicare PIN