MEDICARE: MS. MICHELLE 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
1	225100000X	Physical Therapist	1047454	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1047454	OTHER	TX	PHYSICAL THERAPY EXAMINER

General Provider Information

NPI Number	:	1437148566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE JOHNSON PT

Provider Business Mailing Address
First Line	:	PO BOX 1169
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78680-1169
Country	:	US
Telephone Number	:	512-388-1448
Fax Number	:	512-388-7854

Provider Business Practice Location Address
First Line	:	16020 PARK VALLEY DR
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-3573
Country	:	US
Telephone Number	:	512-388-1448
Fax Number	:	512-388-7854

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	07/08/2007

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Directions to “ MS. MICHELLE JOHNSON PT” Practice Location

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