MEDICARE: MICHAEL TODD JOHNSON CMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	419148-00	WI

General Provider Information

NPI Number	:	1033379474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL TODD JOHNSON CMT

Provider Business Mailing Address
First Line	:	26 W GRAND AVE
Second Line	:
City	:	CHIPPEWA FALLS
State	:	WI
Zip	:	54729-2415
Country	:	US
Telephone Number	:	715-723-4451
Fax Number	:	715-723-4451

Provider Business Practice Location Address
First Line	:	26 W GRAND AVE
Second Line	:
City	:	CHIPPEWA FALLS
State	:	WI
Zip	:	54729-2415
Country	:	US
Telephone Number	:	715-723-4451
Fax Number	:	715-723-4451

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	06/10/2008

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