Provider Demographics
NPI:1821257643
Name:JOHNSON, STEPHANIE MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2152 S HURSTBOURNE PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1622
Mailing Address - Country:US
Mailing Address - Phone:502-499-0107
Mailing Address - Fax:502-499-0535
Practice Address - Street 1:2152 S HURSTBOURNE PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1622
Practice Address - Country:US
Practice Address - Phone:502-499-0107
Practice Address - Fax:502-499-0535
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05013704A2251X0800X
KY0052852251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic