Provider Demographics
NPI:1851166599
Name:JOHNSON-KATZ, JODI (PTA)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:JOHNSON-KATZ
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 1:1111 E WESTVIEW CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1376
Mailing Address - Country:US
Mailing Address - Phone:509-465-1749
Mailing Address - Fax:509-465-1748
Practice Address - Street 1:5919 HIGHWAY 291 STE 6
Practice Address - Street 2:
Practice Address - City:NINE MILE FALLS
Practice Address - State:WA
Practice Address - Zip Code:99026-9007
Practice Address - Country:US
Practice Address - Phone:509-822-7084
Practice Address - Fax:509-822-7279
Is Sole Proprietor?:No
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160029258225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant