Provider Demographics
NPI:1518181759
Name:JOHNSON, ELIZABETH F (LMT)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:F
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 SYCAMORE ST APT 100G
Mailing Address - Street 2:
Mailing Address - City:BELPRE
Mailing Address - State:OH
Mailing Address - Zip Code:45714-2056
Mailing Address - Country:US
Mailing Address - Phone:304-494-9875
Mailing Address - Fax:
Practice Address - Street 1:2804 BIRCH ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-1910
Practice Address - Country:US
Practice Address - Phone:304-494-9875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2003-1232174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist