1437366119 NPI number — MISS RHONDA GALE JOHNSON PTA,ATC

Table of content: MISS RHONDA GALE JOHNSON PTA,ATC (NPI 1437366119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437366119 NPI number — MISS RHONDA GALE JOHNSON PTA,ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
RHONDA
Provider Middle Name:
GALE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PTA,ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437366119
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8430 FOREST BREEZE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-778-3196
Provider Business Mailing Address Fax Number:
423-778-6197

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8430 FOREST BREEZE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37341-6951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-778-3196
Provider Business Practice Location Address Fax Number:
423-778-6197
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225200000X , with the licence number:  0000000157 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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