Individual
FERNANDA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT DPT
Contact information
Practice address
100 SMITHFIELD AVE, PAWTUCKET, RI 02860-3497
(401) 725-9666
(401) 722-5896
Mailing address
100 SMITHFIELD AVE, PAWTUCKET, RI 02860-3497
(401) 725-9666
(401) 722-5896
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
4695
MA
225100000X
Physical Therapist
Primary
PT01869
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
411571
BLUE CROSS BS
—
Enumeration date
03/08/2007
Last updated
07/08/2007
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