Healthcare Provider Details

I. General information

NPI: 1952425662
Provider Name (Legal Business Name): JAN J JOHNSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAN HULSE

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1878 MOUNTAIN RD STE 1
STOWE VT
05672-4775
US

IV. Provider business mailing address

220 THOMAS LN
STOWE VT
05672-5060
US

V. Phone/Fax

Practice location:
  • Phone: 802-253-2273
  • Fax: 802-253-7754
Mailing address:
  • Phone: 802-253-8869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number040-0002878
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: