Individual
ANDREA J JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
210 E GRAY ST STE 807, LOUISVILLE, KY 40202-3927
(502) 587-9350
(502) 587-9351
Mailing address
210 E GRAY ST, LOUISVILLE, KY 40202
(502) 587-9350
(502) 587-9351
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
006014
KY
225100000X
Physical Therapist
05008248A
IN
225100000X
Physical Therapist
Primary
11075
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006014
KY LICENSE NUMBER
KY
01
—
05008248A
IN LICENSE NUMBER
IN
01
—
11075
NC LICENSE NUMBER
NC
Enumeration date
07/23/2007
Last updated
03/01/2016
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