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NPI Code Detail

MEDICARE: MR. ADAM JOHNSON PT, CERT MDT

MEDICARE: MR. ADAM JOHNSON PT, CERT MDT
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 TherapistIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17216OTHERPERSONALCARE PROV ID
2203OTHERILBLUE CROSS PROV ID
3113326OTHERHEALTHLINK PROV ID
44117OTHERILHAMP PROVIDER ID

General Provider Information

NPI Number : 1457470478
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ADAM JOHNSON PT, CERT MDT
Provider Business Mailing Address
First Line : 611 W PARK ST
Second Line :
City : URBANA
State : IL
Zip : 61801-2500
Country : US
Telephone Number : 217-326-2911
Fax Number : 217-344-8047
Provider Business Practice Location Address
First Line : 610 N LINCOLN AVE
Second Line :
City : URBANA
State : IL
Zip : 61801-2432
Country : US
Telephone Number : 217-326-2911
Fax Number : 217-344-8047
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2007
Last Update Date : 07/08/2007

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