MEDICARE: TAYLOR ELISE 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

General Provider Information

NPI Number	:	1467135939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR ELISE JOHNSON DPT

Provider Business Mailing Address
First Line	:	PO BOX 148
Second Line	:
City	:	HARTFORD
State	:	KY
Zip	:	42347-0148
Country	:	US
Telephone Number	:	270-504-1910
Fax Number	:	270-298-3824

Provider Business Practice Location Address
First Line	:	3500 VILLA PT STE 110
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42303-7826
Country	:	US
Telephone Number	:	270-691-0059
Fax Number	:

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

Provider Enumeration Date	:	08/10/2023
Last Update Date	:	08/26/2025

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