Basic Information
| Provider Information | |||||||||
| NPI: | 1205971736 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | JACOBY | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3844 OAK RIDGE CT | ||||||||
| Address2: | |||||||||
| City: | COLGATE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530179361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626281975 | ||||||||
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| Practice Location | |||||||||
| Address1: | N88W16598 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MENOMONEE FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530512845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625020028 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 10/16/2007 | ||||||||
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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 | 4556 - 024 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.