Provider Demographics
NPI:1356996607
Name:JOHNSON, HILLARY (LMT, ATC)
Entity type:Individual
Prefix:
First Name:HILLARY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 W MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-8214
Mailing Address - Country:US
Mailing Address - Phone:518-350-4827
Mailing Address - Fax:
Practice Address - Street 1:484 GLEN ST STE B
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3194
Practice Address - Country:US
Practice Address - Phone:518-350-4827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031237225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty