Individual
MRS. EVELYN - JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
N27W5707 LINCOLN BLVD, CEDARBURG, WI 53012-2852
(262) 376-7676
(262) 376-5208
Mailing address
2203 N 106TH ST, WAUWATOSA, WI 53226-2318
(414) 456-9711
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
50019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22
PHYSICAL THERAPIST ASST.
WI
05
—
40186700
—
WI
01
—
50019
LICENSE
WI
Enumeration date
05/01/2007
Last updated
07/08/2007
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