Provider Demographics
NPI:1821396185
Name:JOHNSON, BETTYE JO (PTA)
Entity Type:Individual
Prefix:MRS
First Name:BETTYE
Middle Name:JO
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 RIGGSBEE FARM DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-7354
Mailing Address - Country:US
Mailing Address - Phone:919-319-0952
Mailing Address - Fax:
Practice Address - Street 1:11200 GOVERNOR MANLY WAY, SUITE 305
Practice Address - Street 2:ORHOPAEDIC SPECIALISTS OF NORTH CAROLINA, PA
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614
Practice Address - Country:US
Practice Address - Phone:919-562-9410
Practice Address - Fax:919-562-9425
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC244208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation