Provider Demographics
NPI:1740378702
Name:JOHANSON, MARIE ANNE (PT, PHD, OCS)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:ANNE
Last Name:JOHANSON
Suffix:
Gender:F
Credentials:PT, PHD, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1441 CLIFTON RD NE
Mailing Address - Street 2:SUITE #170
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1004
Mailing Address - Country:US
Mailing Address - Phone:404-727-6581
Mailing Address - Fax:404-712-4130
Practice Address - Street 1:1441 CLIFTON RD NE
Practice Address - Street 2:SUITE #170
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1004
Practice Address - Country:US
Practice Address - Phone:404-727-6581
Practice Address - Fax:404-712-4130
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT001574225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist