Healthcare Provider Details

I. General information

NPI: 1295081446
Provider Name (Legal Business Name): COURTNEY JOHNSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18601 LINCOLN ST
WHITEHALL WI
54773-8605
US

IV. Provider business mailing address

18601 LINCOLN ST
WHITEHALL WI
54773-8605
US

V. Phone/Fax

Practice location:
  • Phone: 715-538-4361
  • Fax:
Mailing address:
  • Phone: 715-538-4361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number172819
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: