Provider Demographics
NPI:1659609733
Name:JOHNSON, MARY ANN ZACCARIA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN ZACCARIA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6420 E GROUSE RD
Mailing Address - Street 2:
Mailing Address - City:CHATTAROY
Mailing Address - State:WA
Mailing Address - Zip Code:99003-8625
Mailing Address - Country:US
Mailing Address - Phone:509-292-2069
Mailing Address - Fax:
Practice Address - Street 1:14820 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-2165
Practice Address - Country:US
Practice Address - Phone:509-922-1644
Practice Address - Fax:509-922-0246
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist