| NPI | 1760533749 |
|---|---|
| Former Name | ROBERTA L JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 2899) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070012031) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2023-10-24 |