Provider Demographics
NPI:1063411049
Name:JOHNSON, LORI BROWN (MPT)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:BROWN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19465 DEERFIELD AVENUE STE 405
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-1707
Mailing Address - Country:US
Mailing Address - Phone:703-858-1800
Mailing Address - Fax:703-858-1801
Practice Address - Street 1:19465 DEERFIELD AVENUE STE 405
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-1707
Practice Address - Country:US
Practice Address - Phone:703-858-1800
Practice Address - Fax:703-858-1801
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203733225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist