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Kenyetta Johnson
Prosthetic/Orthotic Supplier in Bloomingburg, New York
NPI 1205580636

Kenyetta Johnson is a Prosthetic/Orthotic Supplier based in Middletown, NY. Kenyetta Johnson practices in Bloomingburg, NY. The NPI Number for Kenyetta Johnson is 1205580636 and holds a License No. AEC-21-01947 (New York).

The current practice location address for Kenyetta Johnson is 12 White Birch Trl, Bloomingburg, NY and can be reached out via phone at 845-316-9426 and via fax at 845-316-2366.

Location: 12 White Birch Trl, Bloomingburg, NY, 10940-2252
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1205580636
Provider Name
Kenyetta Johnson
Credential
Provider Entity Type
Individual
Gender
Female
Address
12 White Birch Trl, Bloomingburg, NY, 10940-2252
Phone Number
845-316-9426
Fax Number
845-316-2366
Provider Enumeration Date
02/04/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
12 White Birch Trl
City
Bloomingburg
State
New York
Zip
12721-4933
Phone Number
845-316-9426
Fax Number
845-316-2366
person
Provider Business Mailing Address Details
Address
12 White Birch Trl
City
Bloomingburg
State
New York
Zip
12721-4933
Phone Number
845-316-9426
Fax Number
845-316-2366
person
Provider's Taxonomy Details 1
Type
Suppliers
Classification
Prosthetic/Orthotic Supplier
Speciality
-
Taxonomy
335E00000X
License No.
AEC-21-01947 (New York)
Definition
An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition.
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