Provider Demographics
NPI:1497069322
Name:JOHNSON, TAMEKA A (PT)
Entity type:Individual
Prefix:
First Name:TAMEKA
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TAMEKA
Other - Middle Name:
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2250 WILMA RUDOLPH BLVD STE F178
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-8452
Mailing Address - Country:US
Mailing Address - Phone:931-444-3677
Mailing Address - Fax:931-444-5581
Practice Address - Street 1:327 WARFIELD BLVD STE B
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5611
Practice Address - Country:US
Practice Address - Phone:931-444-3677
Practice Address - Fax:931-444-5581
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8716225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4274674OtherBCBS OF TENNESSEE
TN4274674OtherBCBS OF TENNESSEE