Individual
GILISSA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12825 MINNIEVILLE RD, LAKE RIDGE, VA 22192-3601
(703) 971-3701
Mailing address
20410 CENTURY BLVD STE 215, GERMANTOWN, MD 20874-1187
(240) 731-9641
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305213488
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT34397
PT LICENSE
FL
Enumeration date
02/13/2019
Last updated
03/16/2023
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