Basic Information
| Provider Information | |||||||||
| NPI: | 1629569074 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | VIRGINIA | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 633448 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452633448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138531300 | ||||||||
| FaxNumber: | 5134511356 | ||||||||
| Practice Location | |||||||||
| Address1: | 5520 CHEVIOT RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134514033 | ||||||||
| FaxNumber: | 5134511356 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2018 | ||||||||
| LastUpdateDate: | 05/22/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT008300 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.