Individual
EBONY L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1115 FAIRGROUNDS RD, JEFFERSON CITY, MO 65109-5443
(573) 634-3070
(573) 636-3247
Mailing address
1115 FAIRGROUNDS RD, JEFFERSON CITY, MO 65109-5443
(573) 634-3070
(573) 636-3247
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2019020760
MO
Other
Enumeration date
09/10/2019
Last updated
09/10/2019
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