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NPI Code Detail

MEDICARE: AMY L JOHNSON DPT

MEDICARE: AMY L JOHNSON DPT
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 Therapist070.026950IL

General Provider Information

NPI Number : 1144945254
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY L JOHNSON DPT
Provider Business Mailing Address
First Line : 1138 W BARRY AVE APT G
Second Line :
City : CHICAGO
State : IL
Zip : 60657-6795
Country : US
Telephone Number : 308-293-6144
Fax Number :
Provider Business Practice Location Address
First Line : 7447 N CLARK ST STE B107
Second Line :
City : CHICAGO
State : IL
Zip : 60626-1619
Country : US
Telephone Number : 224-273-6590
Fax Number : 224-273-6591
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2022
Last Update Date : 10/11/2022

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