Individual
SUE ELLEN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 SUNSHINE BLVD, SOLDIERS GROVE, WI 54655-7106
(608) 624-5127
Mailing address
27690 ERMINE AVE, TOMAH, WI 54660-7505
(608) 372-3617
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
975-019
WI
Other
Enumeration date
11/22/2011
Last updated
11/22/2011
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