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NPI Code Detail

MEDICARE: GAIL RENEE JOHNSON P.T.

MEDICARE: GAIL RENEE 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
1225100000XPhysical Therapist070.015476IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00769842OTHERILRAILROAD MEDICARE

General Provider Information

NPI Number : 1588782445
Entity Type Code : Individual
Provider Name (Legal Business Name) : GAIL RENEE JOHNSON P.T.
Provider Business Mailing Address
First Line : PO BOX 19248
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62794-9248
Country : US
Telephone Number : 217-528-7541
Fax Number :
Provider Business Practice Location Address
First Line : 800 N 1ST ST
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62702-3778
Country : US
Telephone Number : 217-528-7541
Fax Number : 217-547-9245
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2007
Last Update Date : 12/20/2024

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