Provider Demographics
NPI:1700900206
Name:JOHNSON, LOVINA TRAMEL (PT)
Entity Type:Individual
Prefix:MS
First Name:LOVINA
Middle Name:TRAMEL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:LOVINA
Other - Middle Name:TRAMEL
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:140 PINECOVE AVE
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-2676
Mailing Address - Country:US
Mailing Address - Phone:410-695-5472
Mailing Address - Fax:
Practice Address - Street 1:JAMES L WEST ALZHEIMER CENTER
Practice Address - Street 2:1111 SUMMIT AVE
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102
Practice Address - Country:US
Practice Address - Phone:817-877-1199
Practice Address - Fax:301-773-4003
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17940225100000X
TX1067247208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist