Basic Information
| Provider Information | |||||||||
| NPI: | 1174744940 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11417 S. MAPLEWOOD AVE. | ||||||||
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| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182988687 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6585 S. YALE AVE. | ||||||||
| Address2: | SUITE 445 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184812977 | ||||||||
| FaxNumber: | 9184811976 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2285 | OK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.