Healthcare Provider Details

I. General information

NPI: 1467484782
Provider Name (Legal Business Name): LISA R JOHNS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 REFUGEE RD
COLUMBUS OH
43232-4416
US

IV. Provider business mailing address

4420 REFUGEE RD
COLUMBUS OH
43232-4416
US

V. Phone/Fax

Practice location:
  • Phone: 614-890-6555
  • Fax: 614-759-1483
Mailing address:
  • Phone: 614-890-6555
  • Fax: 614-759-1483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT006020
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: