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General NPI Number Information
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NPI Number | 1801172010
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Entity Type | Individual
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Provider Name | ABIGAIL JOHNSON PTA
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Gender | Female
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 11/01/2011
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Provider Practice Location Address
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Address Line | 2305 SAN LUIS PL
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City | GREEN BAY
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State | WI
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Zip | 54304-5211
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Country | US
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Telephone | 920-494-5231
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Fax |
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Provider Business Mailing Address
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Address Line | 3235 W POINT RD
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City | GREEN BAY
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State | WI
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Zip | 54313-5219
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Country | US
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Telephone | 920-471-8042
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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 | 1802-019
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License Number State | WI
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