Individual
MARY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1286 E TUTTLE ST, MERIDIAN, ID 83646-5932
(801) 872-3204
Mailing address
1286 E TUTTLE ST, MERIDIAN, ID 83646-5932
(209) 969-2426
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
7067
ID
Other
Enumeration date
08/25/2021
Last updated
08/25/2021
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