Healthcare Provider Details

I. General information

NPI: 1962689018
Provider Name (Legal Business Name): HEATHER L JOHNSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5533 W HILLSDALE AVE SUITE A
VISALIA CA
93291-5138
US

IV. Provider business mailing address

613 N QUINCE AVE APARTMENT A
EXETER CA
93221-1069
US

V. Phone/Fax

Practice location:
  • Phone: 559-733-2478
  • Fax: 559-733-2470
Mailing address:
  • Phone: 559-592-6870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT34408
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License NumberPT34408
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT34408
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License NumberPT34408
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT34408
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT34408
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT34408
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT34408
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: