Individual
SHANNON R JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2030 N 15TH RD, STREATOR, IL 61364-9754
(815) 674-0513
Mailing address
2030 N 15TH RD, STREATOR, IL 61364-9754
(815) 674-0513
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160003038
IL
Other
Enumeration date
04/01/2020
Last updated
04/01/2020
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