Healthcare Provider Details

I. General information

NPI: 1558280362
Provider Name (Legal Business Name): MICHELLE ANN JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 ROTHROCK LOOP STE B
COPLEY OH
44321-1331
US

IV. Provider business mailing address

3502 SANDLEWOOD DR
BRUNSWICK OH
44212-4449
US

V. Phone/Fax

Practice location:
  • Phone: 330-666-2228
  • Fax:
Mailing address:
  • Phone: 330-666-2228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number03497
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: