Provider Demographics
NPI:1598724312
Name:JOHNSON, DENISE R (PT)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:R
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 1:3588 W SMALL RD
Mailing Address - Street 2:
Mailing Address - City:LAPORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-7932
Mailing Address - Country:US
Mailing Address - Phone:219-362-4650
Mailing Address - Fax:219-326-7611
Practice Address - Street 1:602 1ST ST
Practice Address - Street 2:
Practice Address - City:LAPORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3129
Practice Address - Country:US
Practice Address - Phone:219-325-0632
Practice Address - Fax:219-326-7611
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001745225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist