Individual
NIKKI JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
7930 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 432-5800
Mailing address
7930 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05012253A
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201397670
—
IN
Enumeration date
10/14/2016
Last updated
09/20/2017
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