Provider Demographics
NPI:1023619020
Name:JOHNSON, KIMBERLY LITTLE (LPTA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LITTLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7913 RED GLOBE CT
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-1047
Mailing Address - Country:US
Mailing Address - Phone:443-274-2919
Mailing Address - Fax:
Practice Address - Street 1:7913 RED GLOBE CT
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-1047
Practice Address - Country:US
Practice Address - Phone:443-274-2919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA3105225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant