Provider Demographics
NPI:1619219821
Name:JOHNSON, EMILY (PTA)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:NH
Mailing Address - Zip Code:03451-2312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:171 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:NH
Practice Address - Zip Code:03451-2312
Practice Address - Country:US
Practice Address - Phone:603-209-5160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT041.0093171225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant