Provider Demographics
NPI:1932327608
Name:JOHNSON, SHANNA D (MS,PT)
Entity Type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 HUNT RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:LA
Mailing Address - Zip Code:71006-3469
Mailing Address - Country:US
Mailing Address - Phone:318-965-3990
Mailing Address - Fax:318-965-4466
Practice Address - Street 1:115 HUNT RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:LA
Practice Address - Zip Code:71006-3469
Practice Address - Country:US
Practice Address - Phone:318-230-2537
Practice Address - Fax:318-965-4466
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01146225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1861404683OtherNPI-ROLLING REHAB, LLC