MEDICARE: MS. KATHY ANN JOHNSON PT

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	225100000X	Physical Therapist	0495	ND
2	225100000X	Physical Therapist	005034	IA
3	225100000X	Physical Therapist	2457	MN

General Provider Information

NPI Number	:	1427254382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHY ANN JOHNSON PT

Provider Business Mailing Address
First Line	:	115 N MILL ST
Second Line	:
City	:	LAKE MILLS
State	:	IA
Zip	:	50450-1303
Country	:	US
Telephone Number	:	641-592-3500
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 N MILL ST
Second Line	:
City	:	LAKE MILLS
State	:	IA
Zip	:	50450-1303
Country	:	US
Telephone Number	:	641-592-3500
Fax Number	:

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

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	08/03/2012

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