Individual
MICHELLE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
12100 S YUKON AVE STE D, GLENPOOL, OK 74033-6662
(918) 992-6247
(539) 867-7065
Mailing address
PO BOX 632652, CINCINNATI, OH 45263-2652
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4209
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200267380A
—
OK
Enumeration date
11/13/2009
Last updated
01/16/2026
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