Individual
SHELLY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
25 W PLEASANT ST, SPRINGFIELD, OH 45506-2278
(937) 325-7671
(937) 325-9915
Mailing address
2701 SELMA RD, SPRINGFIELD, OH 45505-5105
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
4775
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SEASHELL811
—
OH
Enumeration date
10/08/2014
Last updated
10/08/2014
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