Individual
BREANNA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
700 GENEVA PKWY N, LAKE GENEVA, WI 53147-4594
(262) 249-3500
Mailing address
W3670 WILDWOOD DR, LAKE GENEVA, WI 53147-3567
(847) 431-4847
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2668-19
WI
Other
Enumeration date
04/13/2020
Last updated
04/13/2020
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