Healthcare Provider Details

I. General information

NPI: 1629569074
Provider Name (Legal Business Name): DENISE VIRGINIA JOHNSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 CHEVIOT RD
CINCINNATI OH
45247
US

IV. Provider business mailing address

PO BOX 633448
CINCINNATI OH
45263-3448
US

V. Phone/Fax

Practice location:
  • Phone: 513-451-4033
  • Fax: 513-451-1356
Mailing address:
  • Phone: 513-853-1300
  • Fax: 513-451-1356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT008300
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: