Provider Demographics
NPI:1881880219
Name:JOHNSON, HANNAH LEE (DPT, OCS)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:LEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 WHITMAN DR
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-2210
Mailing Address - Country:US
Mailing Address - Phone:303-325-5329
Mailing Address - Fax:303-670-3323
Practice Address - Street 1:3045 WHITMAN DR
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-2210
Practice Address - Country:US
Practice Address - Phone:303-325-5329
Practice Address - Fax:303-670-3323
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018904225100000X
CO109632251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA117083VL8Medicare PIN