Provider Demographics
NPI:1821358136
Name:JOHNSON, AMY SUE (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SUE
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 1:4900 S ARROWHEAD DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6952
Mailing Address - Country:US
Mailing Address - Phone:816-795-6999
Mailing Address - Fax:816-795-3366
Practice Address - Street 1:4900 S ARROWHEAD DR
Practice Address - Street 2:SUITE B
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6952
Practice Address - Country:US
Practice Address - Phone:816-795-6999
Practice Address - Fax:816-795-3366
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist