Individual
STEPHANIE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
22 TOMPKINS ST, WATERBURY, CT 06708-1458
(203) 598-0600
(203) 598-3300
Mailing address
22 TOMPKINS ST, WATERBURY, CT 06708-1458
(203) 598-0600
(203) 598-3300
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2004
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004190328
—
CT
Enumeration date
09/04/2019
Last updated
09/04/2019
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