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NPI Code Detail

MEDICARE: CAROL JOHNSON P.T.

MEDICARE: CAROL JOHNSON P.T.
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
1174400000XSpecialistPT000098EPA
22251X0800XOrthopedic Physical TherapistPT000098EPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100025508801OTHERNYLEGACY NUMBER - UNIVERA
2457211OTHERPALEGACY NUMBER - HIGHMARK

General Provider Information

NPI Number : 1134192164
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROL JOHNSON P.T.
Provider Business Mailing Address
First Line : 512 E COLUMBUS AVE
Second Line :
City : CORRY
State : PA
Zip : 16407-9014
Country : US
Telephone Number : 814-664-9346
Fax Number : 814-663-0169
Provider Business Practice Location Address
First Line : 512 E COLUMBUS AVE
Second Line :
City : CORRY
State : PA
Zip : 16407-9014
Country : US
Telephone Number : 814-664-9346
Fax Number : 814-663-0169
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2006
Last Update Date : 01/27/2010

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Directions to “ CAROL JOHNSON P.T.” Practice Location

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