Provider Demographics
NPI:1902387111
Name:JOHNSON, ELSA (DPT)
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 UPTOWN AVE APT 2099
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-4808
Mailing Address - Country:US
Mailing Address - Phone:321-684-3599
Mailing Address - Fax:
Practice Address - Street 1:12975 SHERIDAN BLVD
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1477
Practice Address - Country:US
Practice Address - Phone:303-785-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-25
Last Update Date:2018-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0015883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist