Provider Demographics
NPI:1225843774
Name:JOHNSON, GRACE CANETA (PT)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:CANETA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8642 F ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-1639
Mailing Address - Country:US
Mailing Address - Phone:402-393-9390
Mailing Address - Fax:402-393-9388
Practice Address - Street 1:8642 F ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1639
Practice Address - Country:US
Practice Address - Phone:402-393-9390
Practice Address - Fax:402-393-9388
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE865225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist