Individual
MRS. LISA MARIE JOHANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.A.
Contact information
Practice address
100 GLEN COVE AVE, GLEN COVE, NY 11542-2818
(516) 609-2000
(516) 609-2014
Mailing address
12 MCKINLEY PL, GLEN COVE, NY 11542-1927
(516) 801-2480
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
003389-1
NY
Other
Enumeration date
07/20/2010
Last updated
07/20/2010
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