Individual
LOAGAN MACKENZIE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
7213 S SIWELL RD STE A, BYRAM, MS 39272-9776
(601) 346-9191
Mailing address
420 ARAGLEN DRIVE, CANTON, MS 39046
(601) 934-0659
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
PT6875
MS
225100000X
Physical Therapist
Primary
PT6875
MS
Other
Enumeration date
06/03/2020
Last updated
06/03/2020
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