MEDICARE: DR. JARED THORNTON JOHNSON

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	225100000X	Physical Therapist	CP019173T	WA
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1104310663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JARED THORNTON JOHNSON

Provider Business Mailing Address
First Line	:	1002 SAFFELL RD
Second Line	:
City	:	REISTERSTOWN
State	:	MD
Zip	:	21136-6030
Country	:	US
Telephone Number	:	410-596-9654
Fax Number	:

Provider Business Practice Location Address
First Line	:	4416 S BRANDON ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-2341
Country	:	US
Telephone Number	:	206-721-3630
Fax Number	:

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

Provider Enumeration Date	:	06/19/2018
Last Update Date	:	05/30/2023

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