MEDICARE: DR. HOLLY JOHNSON DPT

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	1395	NV

General Provider Information

NPI Number	:	1649214222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOLLY JOHNSON DPT

Provider Business Mailing Address
First Line	:	3831 STEPHANIE RD
Second Line	:
City	:	PAHRUMP
State	:	NV
Zip	:	89060-2236
Country	:	US
Telephone Number	:	775-727-7827
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 S MT CHARLESTON DR
Second Line	:
City	:	PAHRUMP
State	:	NV
Zip	:	89048
Country	:	US
Telephone Number	:	775-751-4015
Fax Number	:

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. HOLLY JOHNSON DPT” Practice Location

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