Healthcare Provider Details

I. General information

NPI: 1073848040
Provider Name (Legal Business Name): DONNA JEANE JOHNSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 DALLAS ST
WACO TX
76704-1711
US

IV. Provider business mailing address

2501 MITCHELL AVE
WACO TX
76708-2711
US

V. Phone/Fax

Practice location:
  • Phone: 254-752-9774
  • Fax:
Mailing address:
  • Phone: 254-227-3945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number1196679
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number4512
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: