Provider Demographics
NPI:1023241650
Name:JOHNSON, MONICA R (PT)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 N 12TH ST
Mailing Address - Street 2:S 120
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1242
Mailing Address - Country:US
Mailing Address - Phone:717-737-9818
Mailing Address - Fax:717-737-2815
Practice Address - Street 1:550 N 12TH ST
Practice Address - Street 2:S 120
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1242
Practice Address - Country:US
Practice Address - Phone:717-737-9818
Practice Address - Fax:717-737-2815
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist