Individual
LAURA MARIE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
1441 W BROADWAY, CENTRALIA, IL 62801
(618) 532-0810
(618) 532-0812
Mailing address
400 N PLEASANT AVE, CENTRALIA, IL 62801
(618) 436-8641
(618) 436-8027
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
070.023507
IL
225100000X
Physical Therapist
070.023507
IL
Other
Enumeration date
02/21/2019
Last updated
07/19/2021
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