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General NPI Number Information
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NPI Number | 1629453519
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Entity Type | Individual
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Provider Name | CONSTANCE JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 07/21/2015
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Last Update Date | 05/22/2020
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Provider Practice Location Address
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Address Line | 15210 I-45 S SUITE 108
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City | CONROE
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State | TX
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Zip | 77384
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Country | US
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Telephone | 832-702-7255
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Fax |
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Provider Business Mailing Address
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Address Line | 79 CANDLE PINE PL
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City | THE WOODLANDS
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State | TX
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Zip | 77381-6437
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1051324
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License Number State | TX
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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 |
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License Number State |
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