Provider Demographics
NPI:1639969561
Name:STEPHENSON, JOHANNA EICKE (PT3372)
Entity type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:EICKE
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:PT3372
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533B KEYWAY DR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-8809
Mailing Address - Country:US
Mailing Address - Phone:601-420-0717
Mailing Address - Fax:601-420-0957
Practice Address - Street 1:533B KEYWAY DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8809
Practice Address - Country:US
Practice Address - Phone:601-420-0717
Practice Address - Fax:601-420-0957
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist