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General NPI Number Information
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NPI Number | 1891764213
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Entity Type | Individual
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Provider Name | JUMAAH INGRAM JOHNSON DPT
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Gender | Female
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1616 WALNUT ST SUITE 210
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City | PHILADELPHIA
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State | PA
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Zip | 19103-5313
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Country | US
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Telephone | 215-545-8717
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Fax | 215-545-9355
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Provider Business Mailing Address
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Address Line | 420 BAINBRIDGE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19147-1568
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Country | US
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Telephone | 215-629-1270
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Fax | 215-629-5531
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | PT017980
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License Number State | PA
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