Healthcare Provider Details

I. General information

NPI: 1356258487
Provider Name (Legal Business Name): AMBER JOHNSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 HALL ST
WIGGINS MS
39577-2631
US

IV. Provider business mailing address

27 LAKE FORGETFUL APT 621
HATTIESBURG MS
39402-8286
US

V. Phone/Fax

Practice location:
  • Phone: 601-928-5281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8283
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: