Basic Information
| Provider Information | |||||||||
| NPI: | 1942459938 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTIN-JOHNSON | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10324 N 62ND DR | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853021231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239790066 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2122 E HIGHLAND AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850164739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027780900 | ||||||||
| FaxNumber: | 6027786606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2008 | ||||||||
| LastUpdateDate: | 09/15/2008 | ||||||||
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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 | 7031 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.