Provider Demographics
NPI:1881698850
Name:JOHNSON, EMILY CLARK (MS, PT)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:CLARK
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7429
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0429
Mailing Address - Country:US
Mailing Address - Phone:757-397-1201
Mailing Address - Fax:757-398-0809
Practice Address - Street 1:2929 LONDON BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3405
Practice Address - Country:US
Practice Address - Phone:757-397-1201
Practice Address - Fax:757-398-0809
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23050040882251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic