Provider Demographics
NPI:1972608487
Name:JOHNSON, LAURA WHELCHEL (PT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:WHELCHEL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:WHELCHEL
Other - Last Name:SUMNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2362 TWO NOTCH RD
Mailing Address - Street 2:COLUMBIA REHABILITATION CLINIC
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2257
Mailing Address - Country:US
Mailing Address - Phone:803-799-7007
Mailing Address - Fax:803-256-8410
Practice Address - Street 1:2362 TWO NOTCH RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2257
Practice Address - Country:US
Practice Address - Phone:803-799-7007
Practice Address - Fax:803-256-8410
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1334225100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH0718Medicaid