Provider Demographics
NPI:1821043035
Name:JOHNSON, CYNTHIA E (PT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 WAKARUSA DR
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4798
Mailing Address - Country:US
Mailing Address - Phone:785-749-1300
Mailing Address - Fax:785-749-4746
Practice Address - Street 1:1311 WAKARUSA DR
Practice Address - Street 2:SUITE 1000
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4798
Practice Address - Country:US
Practice Address - Phone:785-749-1300
Practice Address - Fax:785-749-4746
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1101819225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5548578OtherAETNA
KS623280OtherFIRSTGUARD
KS22940017OtherBCBS KC
KS22940017OtherPHP
KS043216OtherBCBS KS
KS100326430AMedicaid
5548578OtherAETNA