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General NPI Number Information
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NPI Number | 1083577589
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Entity Type | Individual
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Provider Name | DOMINIQUE CAPRI JOHNSON PT
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Gender | Female
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Dates
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Enumeration Date | 12/03/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 3 MYERS DR STE 201
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City | MULLICA HILL
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State | NJ
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Zip | 08062-9515
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Country | US
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Telephone | 856-502-3300
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Fax | 856-294-9241
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Provider Business Mailing Address
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Address Line | 1650 LYNDON FARM CT STE 300
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City | LOUISVILLE
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State | KY
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Zip | 40223-5005
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT033883
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA02386300
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License Number State | NJ
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