Provider Demographics
NPI:1902277130
Name:JOHNSON, ELIZABETH ANN (DPT)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3717
Mailing Address - Country:US
Mailing Address - Phone:845-634-0397
Mailing Address - Fax:845-634-0754
Practice Address - Street 1:120 N MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3717
Practice Address - Country:US
Practice Address - Phone:845-634-0397
Practice Address - Fax:845-634-0754
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003626-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist