Provider Demographics
NPI:1629204359
Name:JOHNSON, ANDREA LANGSTON (DPT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LANGSTON
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 1:1267 ENTERPRISE WAY NW STE B
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-4472
Mailing Address - Country:US
Mailing Address - Phone:256-713-1872
Mailing Address - Fax:256-713-1873
Practice Address - Street 1:12181 COUNTY LINE RD STE 150
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-7740
Practice Address - Country:US
Practice Address - Phone:256-489-3760
Practice Address - Fax:256-713-1873
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH6042225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALCJ5487OtherMEDICARE RR
AL51113159OtherBCBS OF AL
AL051113156OtherBCBS OF ALABAMA
AL051113156OtherBCBS OF ALABAMA