| Doctor Name: | MRS. LISA GRACE JOHNSON |
| NPI Number: | 1184901480 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | P.T. |
| License Number: | 070012040 |
| Business Practice Address: | 1601 Butterfield Trail Kankakee, IL - 60901 |
| Business Phone Number: | 8159366500 |
| Business Fax Number: | 9712065203 |
| Mailing Address: | 4560 Se International Way, Ste. 100 MILWAUKIE |
| State: | OR |
| Postal Code: | 97222 |
| Phone Number: | 9712065200 |
| Fax Number: | 9712065203 |
| NPI Enumeration Date: | 11/15/2011 |
| NPI Last Update Date: | 11/15/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 070012040 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| 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 |