Provider Demographics
NPI:1548551393
Name:JOHNSON, STEVEN LEWIS (LPTA)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:LEWIS
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23951 LAKE SHORE BLVD APT 602B
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-4265
Mailing Address - Country:US
Mailing Address - Phone:216-288-0938
Mailing Address - Fax:
Practice Address - Street 1:23951 LAKE SHORE BLVD APT 602B
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-4265
Practice Address - Country:US
Practice Address - Phone:216-288-0938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1573225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant