Healthcare Provider Details

I. General information

NPI: 1033608781
Provider Name (Legal Business Name): PAIGE DOUGHERTY JOHNSON PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HIGHLAND AVE STE 202
NEEDHAM MA
02494-3035
US

IV. Provider business mailing address

200 HIGHLAND AVE STE 202
NEEDHAM MA
02494-3035
US

V. Phone/Fax

Practice location:
  • Phone: 857-990-6111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070026601
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: