Provider Demographics
NPI:1790162212
Name:DONNA P JOHNSON PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:DONNA P JOHNSON PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:F
Authorized Official - Last Name:PLANTE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:802-265-4055
Mailing Address - Street 1:28 4TH ST
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:VT
Mailing Address - Zip Code:05743-1053
Mailing Address - Country:US
Mailing Address - Phone:802-265-4055
Mailing Address - Fax:802-265-8838
Practice Address - Street 1:28 4TH ST
Practice Address - Street 2:
Practice Address - City:FAIR HAVEN
Practice Address - State:VT
Practice Address - Zip Code:05743-1053
Practice Address - Country:US
Practice Address - Phone:802-265-4055
Practice Address - Fax:802-265-8838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400002348225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty