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Individual

MS. SERENA DENISE JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LPT

Contact information

Practice address
5151A WALNUT STREET, PHILADELPHIA, PA 19139
(610) 733-7539
(215) 878-8870
Mailing address
3900 FORD RD, 14A, PHILADELPHIA, PA 19131-2039
(610) 733-7539
(215) 878-8870

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
PT006315L
PA

Other

Enumeration date
09/24/2010
Last updated
09/24/2010
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