MEDICARE: MELISSA DEANNE 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	42582	CA

General Provider Information

NPI Number	:	1437527165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA DEANNE JOHNSON DPT

Provider Business Mailing Address
First Line	:	1060 MARLIN AVE
Second Line	:
City	:	FOSTER CITY
State	:	CA
Zip	:	94404-1812
Country	:	US
Telephone Number	:	650-571-5205
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 WINWARD WAY STE 101
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94404-2499
Country	:	US
Telephone Number	:	650-571-6800
Fax Number	:

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

Provider Enumeration Date	:	09/11/2015
Last Update Date	:	09/11/2015

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