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NPI Code Detail

MEDICARE: JOHNELMS LLC

MEDICARE: JOHNELMS LLC
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
1225100000XPhysical Therapist

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DD2778OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2CHOI59439OTHERVTVT BLUE CROSS

General Provider Information

NPI Number : 1558306936
Entity Type Code : Organization
Provider Name (Legal Business Name) : JOHNELMS LLC
Provider Business Mailing Address
First Line : 790 LAKE ST
Second Line :
City : BRISTOL
State : NH
Zip : 03222-4548
Country : US
Telephone Number : 603-744-0275
Fax Number : 603-744-9378
Provider Business Practice Location Address
First Line : 790 LAKE ST
Second Line :
City : BRISTOL
State : NH
Zip : 03222-4548
Country : US
Telephone Number : 603-744-0275
Fax Number : 603-744-9378
Authorized Official
Title or Position : VP OF FINANCE
Name : MICHAEL J FORTUNATO
Credential :
Telephone Number : 860-434-9398
Provider Enumeration Date : 06/18/2006
Last Update Date : 02/14/2011

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Directions to “JOHNELMS LLC ” Practice Location

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