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NPI Code Detail

MEDICARE: ELIZABETH H PETRY-JOHNSON

MEDICARE:   ELIZABETH H PETRY-JOHNSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist5036SC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00263714OTHERSCMEDICARE RAILROAD NUMBER

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1943423122OTHERSCINSURANCE PROVIDER NUMBER

General Provider Information

NPI Number : 1003820226
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH H PETRY-JOHNSON
Provider Business Mailing Address
First Line : 1361 W WADE HAMPTON BLVD STE F
Second Line : PMB 207
City : GREER
State : SC
Zip : 29650-1146
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 140 EXECUTIVE DR
Second Line :
City : GREER
State : SC
Zip : 29651-1200
Country : US
Telephone Number : 864-848-6339
Fax Number : 864-848-7203
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2006
Last Update Date : 07/18/2014

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Directions to “ ELIZABETH H PETRY-JOHNSON ” Practice Location

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