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General NPI Number Information
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NPI Number | 1235270570
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Entity Type | Individual
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Provider Name | SCOTT JOHNSON PT, MPT, OCS
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Gender | Male
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 10/15/2014
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Provider Practice Location Address
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Address Line | 25 E WASHINGTON ST SUITE 1310
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City | CHICAGO
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State | IL
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Zip | 60602-1708
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Country | US
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Telephone | 312-259-5712
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Fax |
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Provider Business Mailing Address
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Address Line | 4111 N OAKLEY AVE
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City | CHICAGO
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State | IL
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Zip | 60618-2925
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Country | US
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Telephone | 312-259-5712
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070013698
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License Number State | IL
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