Individual
MRS. STACEY ANN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
702 3RD AVE, KINGSTON, PA 18704-5845
(570) 283-5848
Mailing address
572 W 5TH ST, WEST WYOMING, PA 18644-1700
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
TEI000853
PA
Other
Enumeration date
07/16/2014
Last updated
07/16/2014
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