Healthcare Provider Details

I. General information

NPI: 1972048171
Provider Name (Legal Business Name): MADELINE JOHNSON RT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2016
Last Update Date: 12/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4675 CORNELL RD
BLUE ASH OH
45241-2461
US

IV. Provider business mailing address

345 E 86TH ST APT 16C
NEW YORK NY
10028-4750
US

V. Phone/Fax

Practice location:
  • Phone: 513-272-3999
  • Fax:
Mailing address:
  • Phone: 917-861-5292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberRTL1229
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number43ZA00004673
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number6463
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberTTL16188
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: