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General NPI Number Information
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NPI Number | 1952529075
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Entity Type | Individual
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Provider Name | MARIT ELISE JOHNSON P. T.
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Gender | Female
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 04/24/2014
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Provider Practice Location Address
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Address Line | 850 W HIND DR SUITE 201
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City | HONOLULU
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State | HI
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Zip | 96821-1855
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Country | US
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Telephone | 808-377-5605
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Fax | 808-377-5604
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Provider Business Mailing Address
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Address Line | 850 W HIND DR SUITE 201
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City | HONOLULU
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State | HI
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Zip | 96821-1855
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Country | US
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Telephone | 808-377-5605
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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 | 1198
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2946
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License Number State | HI
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