MEDICARE: CARLY DAWN JOHNS

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
1	225000000X	Orthotic Fitter		CO
2	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1063207827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY DAWN JOHNS

Provider Business Mailing Address
First Line	:	1801 GORDON DR
Second Line	:
City	:	ERIE
State	:	CO
Zip	:	80516-7205
Country	:	US
Telephone Number	:	919-961-3305
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 GORDON DR
Second Line	:
City	:	ERIE
State	:	CO
Zip	:	80516-7205
Country	:	US
Telephone Number	:	919-961-3305
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2025
Last Update Date	:	06/05/2026

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