MEDICARE: ERICA JOHNSON LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	208100000X	Physical Medicine & Rehabilitation Physician
2	111NS0005X	Sports Physician Chiropractor
3	225100000X	Physical Therapist
4	225200000X	Physical Therapy Assistant
5	111NX0100X	Occupational Health Chiropractor

General Provider Information

NPI Number	:	1134884596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERICA JOHNSON LLC

Provider Business Mailing Address
First Line	:	PO BOX 9897
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-0897
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3504 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-4224
Country	:	US
Telephone Number	:	267-687-1839
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ERICA JOHNSON
Credential	:
Telephone Number	:	215-201-8206

Provider Enumeration Date	:	11/01/2021
Last Update Date	:	11/01/2021

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Directions to “ERICA JOHNSON LLC ” Practice Location

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