Individual
TRACI I JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
325 S 1ST AVE, BROKEN BOW, NE 68822-2213
(308) 872-5111
(308) 872-5115
Mailing address
PO BOX 435, BROKEN BOW, NE 68822-0435
(308) 872-5111
(308) 872-5115
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4501
NE
Other
Enumeration date
06/21/2023
Last updated
06/21/2023
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