Provider Demographics
NPI:1780350363
Name:JOHNSON, ANGELA HELEN (PTA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:HELEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 SUN VALLEY VLG
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-6548
Mailing Address - Country:US
Mailing Address - Phone:423-972-7383
Mailing Address - Fax:
Practice Address - Street 1:1017 SUN VALLEY VLG
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-6548
Practice Address - Country:US
Practice Address - Phone:423-972-7383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7768225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant