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Individual
SUE JOHNSON
Active
Individual
SUE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3455
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
195517
MEDCOST
NC
01
—
46447
BCBS
NC
01
—
5529094
AETNA
NC
05
—
7212407
—
NC
Enumeration date
05/19/2006
Last updated
12/08/2008
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