Provider Demographics
NPI:1962619411
Name:JOHNSON, SARAH EILEEN (MPT)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:EILEEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:EILEEN
Other - Last Name:MENNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:7816 TOPAZ LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-3050
Mailing Address - Country:US
Mailing Address - Phone:619-261-1836
Mailing Address - Fax:
Practice Address - Street 1:6475 ALVARADO RD
Practice Address - Street 2:SUITE 118
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5003
Practice Address - Country:US
Practice Address - Phone:616-287-4678
Practice Address - Fax:619-287-0350
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT33248225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist