Basic Information
| Provider Information | |||||||||
| NPI: | 1982924569 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | TERESA | ||||||||
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| Credential: | P.T | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5771 ENID ST | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770091208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1738804400 | ||||||||
| FaxNumber: | 7138698637 | ||||||||
| Practice Location | |||||||||
| Address1: | 6630 ROXBURGH DR STE 171 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770415217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2818900001 | ||||||||
| FaxNumber: | 2818901058 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2010 | ||||||||
| LastUpdateDate: | 06/07/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1116226 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.