=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144498908
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARA ANNE JOHNSON DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2008
-----------------------------------------------------
Last Update Date | 08/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 151 ADAMS LN SUITE 11
-----------------------------------------------------
City | MOUNT JULIET
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37122-3598
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-773-1561
-----------------------------------------------------
Fax | 615-773-1564
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 681478
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37068-1478
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-591-6590
-----------------------------------------------------
Fax | 615-591-6601
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 6798942
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 8970
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------