=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003961137
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN W JOHNSON DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 S HOLMEN DR SUITE 2
-----------------------------------------------------
City | HOLMEN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54636-9467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-526-9888
-----------------------------------------------------
Fax | 608-526-9965
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | E7596 GREENWING LN
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54940-8854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-446-2792
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 9694-024
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------