Provider Demographics
NPI:1861647331
Name:JOHNSON, MIA R (PT)
Entity Type:Individual
Prefix:MS
First Name:MIA
Middle Name:R
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 1:2321 1ST ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-1017
Mailing Address - Country:US
Mailing Address - Phone:202-232-9177
Mailing Address - Fax:202-232-0394
Practice Address - Street 1:2321 1ST ST NW
Practice Address - Street 2:BASEMENT
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-1017
Practice Address - Country:US
Practice Address - Phone:202-489-7260
Practice Address - Fax:202-232-0394
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC767002669225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist