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General NPI Number Information
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NPI Number | 1861647331
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Entity Type | Individual
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Provider Name | MIA R JOHNSON PT
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Gender | Female
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Dates
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Enumeration Date | 11/24/2008
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Last Update Date | 11/24/2008
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Provider Practice Location Address
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Address Line | 2321 1ST ST NW BASEMENT
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City | WASHINGTON
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State | DC
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Zip | 20001-1017
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Country | US
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Telephone | 202-489-7260
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Fax | 202-232-0394
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Provider Business Mailing Address
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Address Line | 2321 1ST ST NW
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City | WASHINGTON
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State | DC
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Zip | 20001-1017
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Country | US
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Telephone | 202-232-9177
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Fax | 202-232-0394
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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 | 767002669
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License Number State | DC
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