Individual
KATHERINE JOHNSON I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
320 N RUBY LN, FAIRVIEW HEIGHTS, IL 62208
(618) 394-9798
Mailing address
320 N RUBY LN, FAIRVIEW HEIGHTS, IL 62208
(618) 394-9798
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160001794
IL
Other
Enumeration date
11/07/2012
Last updated
11/07/2012
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