Healthcare Provider Details

I. General information

NPI: 1184999112
Provider Name (Legal Business Name): JOHANNES FOUNDATION LIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3195 WHISPERING WOODS DR NE
NEW SALISBURY IN
47161-9687
US

IV. Provider business mailing address

3195 WHISPERING WOODS LANE, NE
NEW SALISBURY IN
47161-9687
US

V. Phone/Fax

Practice location:
  • Phone: 812-972-7744
  • Fax: 812-972-7759
Mailing address:
  • Phone: 812-972-7744
  • Fax: 812-972-7759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JEROME JOHANNES
Title or Position: MANAGER
Credential: DPT
Phone: 812-972-7744