Provider Demographics
NPI:1679727671
Name:JOHNSON, JACQUELINE TOINETTE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:TOINETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7733 FORSYTH BLVD STE 2300
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1806
Mailing Address - Country:US
Mailing Address - Phone:618-540-3664
Mailing Address - Fax:618-346-0130
Practice Address - Street 1:7733 FORSYTH BLVD STE 2300
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-1806
Practice Address - Country:US
Practice Address - Phone:618-540-3664
Practice Address - Fax:618-346-0130
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.011823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist