MEDICARE: SUSAN JEAN 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	07011922	IL

General Provider Information

NPI Number	:	1821049628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN JEAN JOHNSON PT

Provider Business Mailing Address
First Line	:	626 EBONY DR
Second Line	:
City	:	OSWEGO
State	:	IL
Zip	:	60543
Country	:	US
Telephone Number	:	630-466-5866
Fax Number	:	630-466-5869

Provider Business Practice Location Address
First Line	:	330 DIVISION DR STE B&E
Second Line	:
City	:	SUGAR GROVE
State	:	IL
Zip	:	60554-9800
Country	:	US
Telephone Number	:	630-777-3141
Fax Number	:	630-777-3142

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	05/24/2018

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Directions to “ SUSAN JEAN JOHNSON PT” Practice Location

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