MEDICARE: BLAKE S 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
1	225100000X	Physical Therapist		WI

General Provider Information

NPI Number	:	1174473888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLAKE S JOHNSON DPT

Provider Business Mailing Address
First Line	:	972 W MAIN ST
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-2039
Country	:	US
Telephone Number	:	608-318-0052
Fax Number	:	608-413-0552

Provider Business Practice Location Address
First Line	:	972 W MAIN ST
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-2039
Country	:	US
Telephone Number	:	608-318-0052
Fax Number	:	608-413-0552

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

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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Directions to “ BLAKE S JOHNSON DPT” Practice Location

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