Provider Demographics
NPI:1912557885
Name:JOHNSON, LISA M (PT, DPT, CLT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT, DPT, CLT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:LUIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, CLT
Mailing Address - Street 1:5884 E 39TH PL
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-2626
Mailing Address - Country:US
Mailing Address - Phone:530-261-3200
Mailing Address - Fax:
Practice Address - Street 1:450 W 6TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-2973
Practice Address - Country:US
Practice Address - Phone:928-502-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics