Individual
LORI JOHANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
200 S 9TH ST, DE PERE, WI 54115-1393
(920) 336-5680
Mailing address
1931 UNIVERSITY AVE, GREEN BAY, WI 54302-3623
(920) 660-1853
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2417-19
WI
Other
Enumeration date
09/27/2016
Last updated
09/27/2016
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