Provider Demographics
NPI:1205971736
Name:JOHNSON, PATRICIA JACOBY (PT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JACOBY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3844 OAK RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:COLGATE
Mailing Address - State:WI
Mailing Address - Zip Code:53017-9361
Mailing Address - Country:US
Mailing Address - Phone:262-628-1975
Mailing Address - Fax:
Practice Address - Street 1:N88W16598 MAIN ST
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-2845
Practice Address - Country:US
Practice Address - Phone:262-502-0028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4556 - 024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist