Individual
THIA MIRANDA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
701 WILLOW ST, PESHTIGO, WI 54157-1165
(715) 582-3962
Mailing address
701 WILLOW ST, PESHTIGO, WI 54157-1165
(711) 558-2014
(715) 582-0803
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2514
WI
Other
Enumeration date
09/21/2016
Last updated
09/21/2016
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