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NPI Code Detail

MEDICARE: JENNIFER M. JOHNSTON PT

MEDICARE: JENNIFER M. JOHNSTON PT
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
1225100000XPhysical Therapist10136-024WI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1859400066OTHERWIMEDICARE

General Provider Information

NPI Number : 1114027737
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER M. JOHNSTON PT
Provider Business Mailing Address
First Line : 3915 30TH AVE
Second Line :
City : KENOSHA
State : WI
Zip : 53144-1957
Country : US
Telephone Number : 262-657-0222
Fax Number : 262-657-7190
Provider Business Practice Location Address
First Line : 315 N MILWAUKEE ST
Second Line :
City : WATERFORD
State : WI
Zip : 53185-4432
Country : US
Telephone Number : 262-514-2700
Fax Number : 262-514-3003
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2006
Last Update Date : 10/31/2011

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Directions to “ JENNIFER M. JOHNSTON PT” Practice Location

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