Provider Demographics
NPI:1023177318
Name:JOHNSON, ROBYN DENISE (PT)
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:DENISE
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 1:110 ANNA ST
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-6011
Mailing Address - Country:US
Mailing Address - Phone:985-639-9737
Mailing Address - Fax:
Practice Address - Street 1:200 N MILITARY RD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-1624
Practice Address - Country:US
Practice Address - Phone:985-641-2996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04337225100000X
MSPT4129225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6500200352Medicare ID - Type UnspecifiedMEDICARE RR