Provider Demographics
NPI:1285376566
Name:JOHNSON, NIKI MICHELE (EP)
Entity type:Individual
Prefix:
First Name:NIKI
Middle Name:MICHELE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:EP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13621 GLENDOWER RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-3876
Mailing Address - Country:US
Mailing Address - Phone:703-220-7462
Mailing Address - Fax:
Practice Address - Street 1:6627 W BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1732
Practice Address - Country:US
Practice Address - Phone:804-340-7142
Practice Address - Fax:804-723-3293
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist