Healthcare Provider Details

I. General information

NPI: 1629360581
Provider Name (Legal Business Name): AFRICA JOANALENE HARRIS-JOHNSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AFRICA JOANALENE HARRIS DPT

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 N STATE ST
CLARKSDALE MS
38614-6517
US

IV. Provider business mailing address

3533 DUNN RD STE 232
FLORISSANT MO
63033-6761
US

V. Phone/Fax

Practice location:
  • Phone: 662-247-1254
  • Fax: 662-624-8101
Mailing address:
  • Phone: 314-839-0002
  • Fax: 314-839-5994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2021050381
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: