Provider Demographics
NPI:1215293790
Name:JOHNSON AND JOHNSON PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:JOHNSON AND JOHNSON PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:WATSENE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-463-1167
Mailing Address - Street 1:17721 FENKELL ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-1513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17721 FENKELL ST
Practice Address - Street 2:SUITE 112
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-1513
Practice Address - Country:US
Practice Address - Phone:313-659-3310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty