Individual
TRACY LYNNE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
887 LINCOLN DR, CONNEAUT, OH 44030-2135
(214) 418-4143
Mailing address
887 LINCOLN DR, CONNEAUT, OH 44030-2135
(316) 708-4550
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
2033587
TX
225200000X
Physical Therapy Assistant
Primary
CP014960A
WV
225200000X
Physical Therapy Assistant
PTA005624
OH
Other
Enumeration date
05/16/2007
Last updated
09/19/2022
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