Provider Demographics
NPI:1184926115
Name:JOHNSON, SUSAN HARDING (DPT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:HARDING
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ELIZABETH
Other - Last Name:HARDING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:19517 TRAIL BAY DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8824
Mailing Address - Country:US
Mailing Address - Phone:919-630-4018
Mailing Address - Fax:
Practice Address - Street 1:3801 UNIVERSITY LAKE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4639
Practice Address - Country:US
Practice Address - Phone:907-561-8681
Practice Address - Fax:907-762-6392
Is Sole Proprietor?:No
Enumeration Date:2010-11-24
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12951225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist