Individual
JANE MARIE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
744 S WEBSTER AVE, GREEN BAY, WI 54301-3505
(920) 433-7822
(920) 433-3651
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7222
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4720
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4720-24
WISCONSIN LICENSE
WI
Enumeration date
08/03/2012
Last updated
03/16/2020
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