Provider Demographics
NPI:1770937609
Name:JOHNSON, LINDY (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:LINDY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SKOKIE BLVD UNIT 106
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4104
Mailing Address - Country:US
Mailing Address - Phone:231-649-1288
Mailing Address - Fax:
Practice Address - Street 1:1000 SKOKIE BLVD UNIT 106
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4104
Practice Address - Country:US
Practice Address - Phone:231-649-1288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294817225100000X
IL070.022508225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist