Basic Information
| Provider Information | |||||||||
| NPI: | 1477702058 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOLL | ||||||||
| FirstName: | JOHANNA | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HANSON | ||||||||
| OtherFirstName: | JOHANNA | ||||||||
| OtherMiddleName: | B | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 13537 BARRETT PARKWAY DR | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | BALLWIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630215899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148219126 | ||||||||
| FaxNumber: | 3148219142 | ||||||||
| Practice Location | |||||||||
| Address1: | 2937 S BRENTWOOD BLVD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631442713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149613804 | ||||||||
| FaxNumber: | 3149611147 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2008 | ||||||||
| LastUpdateDate: | 10/09/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 102453 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.