Provider Demographics
NPI:1366161218
Name:LADD, JOHNNA ELIZABETH (DPT)
Entity type:Individual
Prefix:
First Name:JOHNNA
Middle Name:ELIZABETH
Last Name:LADD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8668 MILLBRANCH RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-2316
Mailing Address - Country:US
Mailing Address - Phone:901-647-2210
Mailing Address - Fax:
Practice Address - Street 1:221 LINDLEY LN
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112-4954
Practice Address - Country:US
Practice Address - Phone:870-523-2124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist