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General NPI Number Information
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NPI Number | 1871622100
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Entity Type | Individual
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Provider Name | PEARL TERESA JOHNSON-VANN P.T.
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Gender | Female
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Dates
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Enumeration Date | 03/04/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 407 CHURCH ST NE STE D
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City | VIENNA
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State | VA
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Zip | 22180-4737
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Country | US
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Telephone | 703-242-1921
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Fax | 703-242-1922
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Provider Business Mailing Address
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Address Line | 3504 OLIVE BRANCH DR
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City | SILVER SPRING
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State | MD
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Zip | 20904-4907
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Country | US
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Telephone | 301-890-4976
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 2305003957
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 16351
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License Number State | MD
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