Individual
CARRIE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
240 S MOUNT AUBURN RD, CAPE GIRARDEAU, MO 63703-4918
(573) 334-6711
Mailing address
936 N WEST LN, JACKSON, MO 63755-1093
(573) 979-0919
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
117095
LICENSE
MO
Enumeration date
08/30/2006
Last updated
07/08/2007
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