Provider Demographics
NPI:1821282062
Name:JOHNSON, JANICE (PT)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
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 1:440 E ROOSEVELT RD
Mailing Address - Street 2:UNIT 104
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-3902
Mailing Address - Country:US
Mailing Address - Phone:630-876-9186
Mailing Address - Fax:630-876-9187
Practice Address - Street 1:440 E ROOSEVELT RD
Practice Address - Street 2:UNIT 104
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-3902
Practice Address - Country:US
Practice Address - Phone:630-876-9186
Practice Address - Fax:630-876-9187
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.003651225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK23893Medicare PIN