Provider Demographics
NPI:1942324322
Name:JOHNSON, LINDA CHRISTINE (PT)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:CHRISTINE
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:PO BOX 496084
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-6084
Mailing Address - Country:US
Mailing Address - Phone:530-241-0473
Mailing Address - Fax:530-241-5377
Practice Address - Street 1:2895 CHURN CREEK RD
Practice Address - Street 2:STE D
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1155
Practice Address - Country:US
Practice Address - Phone:530-222-3622
Practice Address - Fax:530-222-3657
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15151225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPT151510Medicare ID - Type Unspecified