| NPI | 1013358191 |
|---|---|
| Former Name | STEPHANIE NICOLE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT021175) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.019878) |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2021-03-30 |