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NPI Code Detail

MEDICARE: SARAH JOHNSON

MEDICARE: SARAH 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
1172M00000XMechanotherapist

General Provider Information

NPI Number : 1346776853
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH JOHNSON
Provider Business Mailing Address
First Line : 620 1/2 ALTO ST
Second Line :
City : SANTA FE
State : NM
Zip : 87501-2519
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 933 BACA ST
Second Line :
City : SANTA FE
State : NM
Zip : 87505-0921
Country : US
Telephone Number : 505-629-3116
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2017
Last Update Date : 05/03/2017

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