Healthcare Provider Details

I. General information

NPI: 1295531416
Provider Name (Legal Business Name): JULIETTE JOHNSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1088 W PRAIRIE AVE
COEUR D ALENE ID
83815-8741
US

IV. Provider business mailing address

1450 NORTHWEST BLVD STE 106
COEUR D ALENE ID
83814-5605
US

V. Phone/Fax

Practice location:
  • Phone: 208-772-6609
  • Fax:
Mailing address:
  • Phone: 208-667-6264
  • Fax: 208-664-4313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: