Provider Demographics
NPI:1609121755
Name:JOHNSON, ERIN REBECCA (DPT)
Entity Type:Individual
Prefix:MISS
First Name:ERIN
Middle Name:REBECCA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3504
Mailing Address - Country:US
Mailing Address - Phone:401-782-4049
Mailing Address - Fax:401-782-0890
Practice Address - Street 1:163 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3504
Practice Address - Country:US
Practice Address - Phone:401-782-4049
Practice Address - Fax:401-782-0890
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT00376-G225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist