Healthcare Provider Details

I. General information

NPI: 1225048093
Provider Name (Legal Business Name): JERRI L JOHNSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JERRI L QUESENBERRY DPT

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 BAYOU BLVD
PENSACOLA FL
32503-2158
US

IV. Provider business mailing address

2441 N 9TH AVE STE B
PENSACOLA FL
32503-3989
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-6710
  • Fax: 850-416-6710
Mailing address:
  • Phone: 850-416-7656
  • Fax: 850-416-6710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT20495
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberPT20495
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: