Healthcare Provider Details

I. General information

NPI: 1932327608
Provider Name (Legal Business Name): SHANNA D. JOHNSON MS,PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 HUNT RD
BENTON LA
71006-3469
US

IV. Provider business mailing address

115 HUNT RD
BENTON LA
71006-3469
US

V. Phone/Fax

Practice location:
  • Phone: 318-230-2537
  • Fax: 318-965-4466
Mailing address:
  • Phone: 318-965-3990
  • Fax: 318-965-4466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number01146
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: