Individual
LISA L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.A.
Contact information
Practice address
1190 E PARADISE DR, WEST BEND, WI 53095-5444
(262) 306-6319
(262) 306-2964
Mailing address
1700 W PARADISE DR, WEST BEND, WI 53095-9795
(262) 306-6319
(262) 306-2964
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
378
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
378-19
STATE LICENSE
WI
Enumeration date
02/18/2010
Last updated
02/19/2010
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