Healthcare Provider Details

I. General information

NPI: 1679179790
Provider Name (Legal Business Name): KARIS JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2020
Last Update Date: 12/06/2020
Certification Date: 12/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 PLAINFIELD ST
PHILADELPHIA PA
19150-3410
US

IV. Provider business mailing address

909 PLAINFIELD ST # 19150
PHILADELPHIA PA
19150-3410
US

V. Phone/Fax

Practice location:
  • Phone: 267-701-5338
  • Fax:
Mailing address:
  • Phone: 267-701-5338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: