Provider Demographics
NPI:1669540001
Name:JOHNSON, JOHHNA G (MSPT)
Entity type:Individual
Prefix:MISS
First Name:JOHHNA
Middle Name:G
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 754
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-0754
Mailing Address - Country:US
Mailing Address - Phone:808-261-9792
Mailing Address - Fax:808-356-1078
Practice Address - Street 1:38 KANEOHE BAY DR
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1747
Practice Address - Country:US
Practice Address - Phone:808-261-9792
Practice Address - Fax:808-356-1078
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT1692225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI56116Medicare ID - Type UnspecifiedPHYSICAL THERAPIST