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General NPI Number Information
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NPI Number | 1740636224
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Entity Type | Individual
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Provider Name | ANELISA JOHNSON DPT
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Gender | Female
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Dates
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Enumeration Date | 05/13/2016
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Last Update Date | 11/25/2019
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Provider Practice Location Address
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Address Line | 2135 GENERAL BOOTH BLVD BLVD #152
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-5881
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Country | US
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Telephone | 540-597-3367
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Fax |
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Provider Business Mailing Address
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Address Line | 4439 VIRGINIA BEACH BLVD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-3100
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Country | US
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Telephone | 757-507-0015
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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 | 2305210192
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License Number State | VA
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