| Doctor Name: | LANDRIE MICHELE JOHANSEN |
| NPI Number: | 1144507245 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | 1212126 |
| Business Practice Address: | 5601 Bridge St Ste 500 Fort Worth, TX - 761122352 |
| Business Phone Number: | 8174579850 |
| Business Fax Number: | 8172870001 |
| Mailing Address: | 2314 Fishermans Rd, SAN ANGELO |
| State: | TX |
| Postal Code: | 769047865 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 11/03/2011 |
| NPI Last Update Date: | 11/03/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 1212126 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |