Provider Demographics
NPI:1356113377
Name:TODD JOHNSON, ANGELA CRYSTELL (PTA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:CRYSTELL
Last Name:TODD JOHNSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1338 LIMESTONE ST
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-6525
Mailing Address - Country:US
Mailing Address - Phone:843-333-4820
Mailing Address - Fax:
Practice Address - Street 1:1056 TPC BLVD
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-8912
Practice Address - Country:US
Practice Address - Phone:843-333-4820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3301225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant