Provider Demographics
NPI:1841030541
Name:JOHNSON, ANIKA (PT, DPT, NCS)
Entity type:Individual
Prefix:
First Name:ANIKA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT, DPT, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 N SUNNYSLOPE DR UNIT 203
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-6328
Mailing Address - Country:US
Mailing Address - Phone:608-225-8699
Mailing Address - Fax:
Practice Address - Street 1:13200 GLOBE DR STE 206
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53177-1615
Practice Address - Country:US
Practice Address - Phone:262-260-8451
Practice Address - Fax:262-995-7360
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.025706225100000X
WI13002-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist