Healthcare Provider Details

I. General information

NPI: 1700984705
Provider Name (Legal Business Name): VIRGINIA ELIZABETH JOHNSON MS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 S CLARKSON ST SUITE 420
DENVER CO
80210-1625
US

IV. Provider business mailing address

182 S HUMBOLDT ST
DENVER CO
80209-2516
US

V. Phone/Fax

Practice location:
  • Phone: 303-507-6521
  • Fax: 303-813-1467
Mailing address:
  • Phone: 303-507-6521
  • Fax: 303-813-1467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number4376
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: