Provider Demographics
NPI:1659554418
Name:JOHNSON, MEGHAN RL (PT)
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:RL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MEGHAN
Other - Middle Name:R
Other - Last Name:LINDSAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1003 RIVER ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-1754
Mailing Address - Country:US
Mailing Address - Phone:831-457-1800
Mailing Address - Fax:831-457-1802
Practice Address - Street 1:1003 RIVER ST
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-1754
Practice Address - Country:US
Practice Address - Phone:831-457-1800
Practice Address - Fax:831-457-1802
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH27122251P0200X
CA2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics