Individual
EBBA M JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
524 74TH STREET, KENOSHA, WI 53143
(262) 496-0258
(262) 657-7784
Mailing address
524 74TH STREET, KENOSHA, WI 53143
(262) 496-0258
(262) 657-7784
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2940
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40167500
—
WI
Enumeration date
04/15/2008
Last updated
04/02/2009
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