MEDICARE: JOHNER THERAPY INC

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
2	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT6139	OTHER	FL	MEDICAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760036560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNER THERAPY INC

Provider Business Mailing Address
First Line	:	11621 S CLEVELAND AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-2866
Country	:	US
Telephone Number	:	239-533-9903
Fax Number	:	239-307-6110

Provider Business Practice Location Address
First Line	:	11621 S CLEVELAND AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-2866
Country	:	US
Telephone Number	:	239-533-9903
Fax Number	:	239-307-6110

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. KIM JOHNER
Credential	:
Telephone Number	:	239-533-9903

Provider Enumeration Date	:	07/30/2019
Last Update Date	:	07/30/2019

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