Individual
MRS. KATHLEEN SARAH JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
587 PALM CANYON DR STE. 204, BORREGO SPRINGS, CA 92004-2630
(760) 767-4047
(760) 767-4048
Mailing address
PO BOX 2630, BORREGO SPRINGS, CA 92004-2630
(760) 767-4047
(760) 767-4048
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
PT9855
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4006834
—
CA
Enumeration date
11/23/2005
Last updated
07/19/2011
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