Basic Information
| Provider Information | |||||||||
| NPI: | 1932213105 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | COURTNEY | ||||||||
| MiddleName: | EILEEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 540 SHEPHERDS DR | ||||||||
| Address2: | |||||||||
| City: | WEST BEND | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530908488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2623068450 | ||||||||
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| Practice Location | |||||||||
| Address1: | 540 SHEPHERDS DR | ||||||||
| Address2: | |||||||||
| City: | WEST BEND | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530908488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2623068450 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| 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 | 2251P0200X | 10639 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics |
No ID Information.