Healthcare Provider Details

I. General information

NPI: 1902594286
Provider Name (Legal Business Name): DAWN MARIE JOHNSON LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DAWN HOWE

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 COMPASS RD
GLENVIEW IL
60026-8001
US

IV. Provider business mailing address

167 MUSKEGON BLVD
MUSKEGON MI
49442-1834
US

V. Phone/Fax

Practice location:
  • Phone: 877-787-3422
  • Fax: 847-441-4130
Mailing address:
  • Phone: 231-531-1271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502003625
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: