Individual
SHIRLEY JEAN JOHNSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2499 W COTA DR, BLOOMINGTON, IN 47403-4217
(812) 337-0210
(812) 337-0211
Mailing address
PO BOX 5635, ATTN: MARIA MITCHELL, BLOOMINGTON, IN 47407
(812) 337-5003
(812) 337-5010
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06003063A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2157141
FIRST HEALTH (CSC)
IN
Enumeration date
09/16/2005
Last updated
07/08/2007
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