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NPI Code Detail

MEDICARE: DR. SHANETTE JOHNSON PT, DPT

MEDICARE: DR. SHANETTE JOHNSON PT, DPT
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
1225100000XPhysical Therapist41706CA

General Provider Information

NPI Number : 1487056206
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHANETTE JOHNSON PT, DPT
Provider Business Mailing Address
First Line : 5535 WESTLAWN AVE APT 160
Second Line :
City : LOS ANGELES
State : CA
Zip : 90066-7090
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6820 S CENTINELA AVE
Second Line :
City : CULVER CITY
State : CA
Zip : 90230-6301
Country : US
Telephone Number : 310-337-7115
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2014
Last Update Date : 09/24/2014

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