Provider Demographics
NPI:1053597625
Name:JOHNSON, SABRINA KIMBERLY-HOWELL (PTA)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:KIMBERLY-HOWELL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3187 WESTERN ROW RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-8045
Mailing Address - Country:US
Mailing Address - Phone:513-459-8599
Mailing Address - Fax:513-459-8746
Practice Address - Street 1:3187 WESTERN ROW RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039-8045
Practice Address - Country:US
Practice Address - Phone:513-459-8599
Practice Address - Fax:513-459-8746
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH05408225200000X
OHPTA05408225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant