Healthcare Provider Details

I. General information

NPI: 1104416452
Provider Name (Legal Business Name): KATHRYN ELIZABETH JOHNSON PT, DPT, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 AMHERST AVE STE 102
SILVER SPRING MD
20902-4665
US

IV. Provider business mailing address

6042 KENNARD CT
ELDERSBURG MD
21784-8422
US

V. Phone/Fax

Practice location:
  • Phone: 301-933-7827
  • Fax:
Mailing address:
  • Phone: 443-293-2113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number28354
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: