Individual
MIA NICHOLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
300 RUE BEAUREGARD, LAFAYETTE, LA 70508-8511
(337) 261-9188
Mailing address
1414 RUPERT LK RD, EUNICE, LA 70535
(337) 849-4355
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
02689
LA
Other
Enumeration date
11/25/2025
Last updated
11/25/2025
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