Provider Demographics
NPI:1881402451
Name:JOHNSON, SYDNEY ELISABETH (DPT)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:ELISABETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:ELISABETH
Other - Last Name:BLAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1579 S AZURE RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-2295
Mailing Address - Country:US
Mailing Address - Phone:208-821-7352
Mailing Address - Fax:
Practice Address - Street 1:617 E RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8719
Practice Address - Country:US
Practice Address - Phone:435-673-4303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT141972552401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist