MEDICARE: MATTHEW JOHNSON DPT, OCS, FAAOMPT

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	2251E1300X	Clinical Electrophysiology Physical Therapist
2	225100000X	Physical Therapist	070-019011	IL

General Provider Information

NPI Number	:	1417222316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW JOHNSON DPT, OCS, FAAOMPT

Provider Business Mailing Address
First Line	:	3228 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1602
Country	:	US
Telephone Number	:	773-857-0689
Fax Number	:	773-857-0769

Provider Business Practice Location Address
First Line	:	3228 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1602
Country	:	US
Telephone Number	:	773-857-0689
Fax Number	:	773-857-0769

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

Provider Enumeration Date	:	03/12/2012
Last Update Date	:	03/19/2024

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