Healthcare Provider Details

I. General information

NPI: 1992224091
Provider Name (Legal Business Name): REBECCA JOHNSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 NEWPORT AVE
CHRISTIANA PA
17509-1305
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 610-593-6901
  • Fax: 610-857-1816
Mailing address:
  • Phone: 630-296-2222
  • Fax: 630-759-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT026195
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: