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NPI Code Detail

MEDICARE: MARILYNNE JOHNSON PT

MEDICARE: MARILYNNE JOHNSON 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 Therapist040-0001066VT

Other Identifiers

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

General Provider Information

NPI Number : 1306829312
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARILYNNE JOHNSON PT
Provider Business Mailing Address
First Line : PO BOX 805
Second Line :
City : RICHMOND
State : VT
Zip : 05477-0805
Country : US
Telephone Number : 802-878-9513
Fax Number : 802-878-9962
Provider Business Practice Location Address
First Line : 67 LINCOLN ST
Second Line :
City : ESSEX JUNCTION
State : VT
Zip : 05452-3235
Country : US
Telephone Number : 802-878-9513
Fax Number : 802-878-9513
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2005
Last Update Date : 01/09/2024

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