| NPI | 1336505676 |
|---|---|
| Former Name | REBECCA MAE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 28767) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MD A0000877) |
| Enumeration Date | 2015-12-31 |
| Last Update Date | 2023-11-15 |