Healthcare Provider Details

I. General information

NPI: 1356232979
Provider Name (Legal Business Name): DEE JOHNSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 MANCHESTER AVE
SAINT LOUIS MO
63110-2012
US

IV. Provider business mailing address

4591 MCREE AVE APT 248
SAINT LOUIS MO
63110-2237
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-5845
  • Fax:
Mailing address:
  • Phone: 573-768-1261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2021002429
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: