Provider Demographics
NPI:1851377568
Name:JOHNSON, LAURIE G (PT)
Entity type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:G
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 1:2030 MASTERS LN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4425
Mailing Address - Country:US
Mailing Address - Phone:713-539-7499
Mailing Address - Fax:713-621-2491
Practice Address - Street 1:3100 TIMMONS LN STE 120
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5925
Practice Address - Country:US
Practice Address - Phone:713-621-2486
Practice Address - Fax:713-621-2491
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1088946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
83705TOtherBLUE CROSS BLUE SHIELD
TX1088946OtherSTATE LIC NUMBER
AK125544OtherAK LIC NUMBER