Provider Demographics
NPI:1427510445
Name:JOHNSON, CORTNEY (LICENSED PTA)
Entity type:Individual
Prefix:
First Name:CORTNEY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LICENSED PTA
Other - Prefix:
Other - First Name:CORTNEY
Other - Middle Name:
Other - Last Name:MADDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICENSED PTA
Mailing Address - Street 1:1151 POLLEN LOOP
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-8588
Mailing Address - Country:US
Mailing Address - Phone:843-655-4838
Mailing Address - Fax:
Practice Address - Street 1:120 LAKES AT LITCHFIELD DR
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-9001
Practice Address - Country:US
Practice Address - Phone:843-314-5642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3703225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant