Healthcare Provider Details

I. General information

NPI: 1407575533
Provider Name (Legal Business Name): ABIGAIL DEVIN JOHNSON DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 PACIFIC AVE
EVERETT WA
98201-4168
US

IV. Provider business mailing address

11400 NE 132ND ST APT R206
KIRKLAND WA
98034-6319
US

V. Phone/Fax

Practice location:
  • Phone: 360-909-2902
  • Fax:
Mailing address:
  • Phone: 360-909-2902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: