Individual
JESSICA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4602 EASTPARK BLVD, MADISON, WI 53718-2002
(608) 440-6440
Mailing address
557 N WASHINGTON ST, JANESVILLE, WI 53548-2907
(608) 754-6000
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10400-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40454800
—
WI
Enumeration date
08/25/2006
Last updated
03/23/2021
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