Healthcare Provider Details

I. General information

NPI: 1497045363
Provider Name (Legal Business Name): HILARY JOHNSON L..P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 SERRANIA AVE
WOODLAND HILLS CA
91364-3301
US

IV. Provider business mailing address

4900 SERRANIA AVE
WOODLAND HILLS CA
91364-3301
US

V. Phone/Fax

Practice location:
  • Phone: 818-347-1577
  • Fax: 818-347-0184
Mailing address:
  • Phone: 818-347-1577
  • Fax: 818-347-0184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number34002
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: