Basic Information
| Provider Information | |||||||||
| NPI: | 1104416452 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | PT, DPT, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6042 KENNARD CT | ||||||||
| Address2: | |||||||||
| City: | ELDERSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217848422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4432932113 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11301 AMHERST AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209024665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019337827 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2021 | ||||||||
| LastUpdateDate: | 01/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 2251X0800X | 28354 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 2251S0007X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports |
No ID Information.