Basic Information
| Provider Information | |||||||||
| NPI: | 1184071615 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | JOHNSON | ||||||||
| FirstName: | CHRISTINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5839 REED LN SE | ||||||||
| Address2: | APT 111 | ||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973062979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705812658 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25117 SW PARKWAY AVE | ||||||||
| Address2: | SUITE D | ||||||||
| City: | WILSONVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970709697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035703665 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2016 | ||||||||
| LastUpdateDate: | 05/13/2016 | ||||||||
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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 | 225200000X | 09301 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.