MEDICARE: KATHLEEN M JOHNSON LPT

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	00342	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104951714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN M JOHNSON LPT

Provider Business Mailing Address
First Line	:	418 N HIGHWAY 19
Second Line	:
City	:	MONTGOMERY CITY
State	:	MO
Zip	:	63361-5217
Country	:	US
Telephone Number	:	573-564-2278
Fax Number	:	573-564-6182

Provider Business Practice Location Address
First Line	:	COUNTY OF MONTGOMERY SCHOOL DIST R 11
Second Line	:	418 N HIGHWAY 19
City	:	MONTGOMERY CITY
State	:	MO
Zip	:	63361-5217
Country	:	US
Telephone Number	:	573-564-2278
Fax Number	:	573-564-6182

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	02/19/2009

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