Individual
THERESA B JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
46 DIAMOND DR, DINWIDIE HEALTH AND REHAB CTR, PETERSBURG, VA 23803-7495
(804) 861-1324
Mailing address
5203 KIMMERIDGE LOOP, MOSELEY, VA 23120-1593
(804) 739-3207
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306602738
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2306602738
PTA
VA
Enumeration date
03/26/2007
Last updated
07/01/2010
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