MEDICARE: SABRINA KIMBERLY-HOWELL JOHNSON PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	05408	OH
2	225200000X	Physical Therapy Assistant	PTA05408	OH

General Provider Information

NPI Number	:	1053597625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SABRINA KIMBERLY-HOWELL JOHNSON PTA

Provider Business Mailing Address
First Line	:	3187 WESTERN ROW RD
Second Line	:	SUITE 102
City	:	MAINEVILLE
State	:	OH
Zip	:	45039-8045
Country	:	US
Telephone Number	:	513-459-8599
Fax Number	:	513-459-8746

Provider Business Practice Location Address
First Line	:	3187 WESTERN ROW RD
Second Line	:	SUITE 102
City	:	MAINEVILLE
State	:	OH
Zip	:	45039-8045
Country	:	US
Telephone Number	:	513-459-8599
Fax Number	:	513-459-8746

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2008
Last Update Date	:	01/14/2008

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