Provider Demographics
NPI:1164638979
Name:JOHNSON, MARNIE MICHELE (PT)
Entity type:Individual
Prefix:
First Name:MARNIE
Middle Name:MICHELE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARNIE
Other - Middle Name:MICHELE
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:2746 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-1511
Mailing Address - Country:US
Mailing Address - Phone:562-260-5754
Mailing Address - Fax:
Practice Address - Street 1:1730 GRAND AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2011
Practice Address - Country:US
Practice Address - Phone:562-597-8817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 23881225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist