Provider Demographics
NPI:1740329994
Name:JOHNSON, TAMMY W (PT)
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:W
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 ALPINE AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3305
Mailing Address - Country:US
Mailing Address - Phone:303-444-0378
Mailing Address - Fax:
Practice Address - Street 1:2015 VAUGHN RD NW
Practice Address - Street 2:STE 130
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7801
Practice Address - Country:US
Practice Address - Phone:770-425-6661
Practice Address - Fax:770-425-1189
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0017859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist