Individual
MRS. DANIELLE G JOHANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
20816
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1868828
AETNA HMO
MD
01
—
61813504
BLUE SHIELD-PPN
MD
01
—
7669448
AETNA NONHMO
MD
01
—
W2660019
BLUE SHIELD GHMI
MD
Enumeration date
07/19/2006
Last updated
09/11/2008
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