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NPI Code Detail

MEDICARE: MRS. ELIZABETH KEYSER JOHNSON RBT

MEDICARE: MRS. ELIZABETH KEYSER JOHNSON RBT
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
1106S00000XBehavior TechnicianAZ

General Provider Information

NPI Number : 1609610310
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELIZABETH KEYSER JOHNSON RBT
Provider Business Mailing Address
First Line : 1351 E MURIEL DR
Second Line :
City : PHOENIX
State : AZ
Zip : 85022-2067
Country : US
Telephone Number : 602-692-8637
Fax Number :
Provider Business Practice Location Address
First Line : 665 N GILBERT RD STE 152
Second Line :
City : GILBERT
State : AZ
Zip : 85234-3395
Country : US
Telephone Number : 480-241-4095
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2024
Last Update Date : 06/19/2024

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