Individual
SHANNON ELIZABETH JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
12600 N PORT WASHINGTON RD, MEQUON, WI 53092-3469
(262) 387-8800
Mailing address
4151 N PROSPECT AVE, SHOREWOOD, WI 53211-1741
(414) 254-0235
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2622-19
WI
Other
Enumeration date
08/24/2017
Last updated
12/13/2021
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