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NPI Code Detail

MEDICARE: MRS. JACQUELINE TOINETTE JOHNSON PHYSICAL THERAPIST

MEDICARE: MRS. JACQUELINE TOINETTE JOHNSON PHYSICAL THERAPIST
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 Therapist070.011823IL

General Provider Information

NPI Number : 1679727671
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JACQUELINE TOINETTE JOHNSON PHYSICAL THERAPIST
Provider Business Mailing Address
First Line : 7733 FORSYTH BLVD STE 2300
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63105-1806
Country : US
Telephone Number : 618-540-3664
Fax Number : 618-346-0130
Provider Business Practice Location Address
First Line : 7733 FORSYTH BLVD STE 2300
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63105-1806
Country : US
Telephone Number : 618-540-3664
Fax Number : 618-346-0130
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2008
Last Update Date : 04/13/2009

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Directions to “ MRS. JACQUELINE TOINETTE JOHNSON PHYSICAL THERAPIST” Practice Location

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