Provider Demographics
NPI:1396772307
Name:JOHNSON, AISHA RASHIDA (PTA)
Entity type:Individual
Prefix:MISS
First Name:AISHA
Middle Name:RASHIDA
Last Name: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 1:8150 OAKLANDON RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-9525
Mailing Address - Country:US
Mailing Address - Phone:317-823-8400
Mailing Address - Fax:317-823-8402
Practice Address - Street 1:8150 OAKLANDON RD
Practice Address - Street 2:SUITE 111
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-9525
Practice Address - Country:US
Practice Address - Phone:317-823-8400
Practice Address - Fax:317-823-8402
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003008A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant