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General NPI Number Information
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NPI Number | 1023347374
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Entity Type | Individual
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Provider Name | SARAH MARIE JOHNSON P.T.A.
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Gender | Female
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Dates
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Enumeration Date | 12/16/2009
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Last Update Date | 12/16/2009
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Provider Practice Location Address
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Address Line | 375 S 11TH ST
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City | CLINTON
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State | IN
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Zip | 47842-1053
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Country | US
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Telephone | 765-832-2491
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Fax |
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Provider Business Mailing Address
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Address Line | 4881 E BRENTWOOD AVE
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City | TERRE HAUTE
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State | IN
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Zip | 47805-9791
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Country | US
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Telephone | 812-249-9665
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 06003867A
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License Number State | IN
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