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NPI Code Detail

MEDICARE: LATASHA JOHNSON

MEDICARE: LATASHA JOHNSON
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
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1922422005
Entity Type Code : Individual
Provider Name (Legal Business Name) : LATASHA JOHNSON
Provider Business Mailing Address
First Line : 4218 BURTON ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-6121
Country : US
Telephone Number : 616-726-1985
Fax Number :
Provider Business Practice Location Address
First Line : 4218 BURTON ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-6121
Country : US
Telephone Number : 616-726-1985
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2014
Last Update Date : 01/21/2026

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Directions to “ LATASHA JOHNSON ” Practice Location

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