Healthcare Provider Details

I. General information

NPI: 1912062944
Provider Name (Legal Business Name): CARIN JOHNS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 JANESVILLE ST
OREGON WI
53575-2954
US

IV. Provider business mailing address

4666 RUTLAND DUNN TOWNLINE RD
OREGON WI
53575-2254
US

V. Phone/Fax

Practice location:
  • Phone: 608-835-5373
  • Fax: 608-835-0373
Mailing address:
  • Phone: 608-443-8590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10486-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: