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NPI Code Detail

MEDICARE: CHAMPLAIN SPORTS MEDICINE PC

MEDICARE: CHAMPLAIN SPORTS MEDICINE PC
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
1204C00000XSports Medicine (Neuromusculoskeletal Medicine) Physician
2204C00000XSports Medicine (Neuromusculoskeletal Medicine) Physician0320000304VT

General Provider Information

NPI Number : 1518106491
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHAMPLAIN SPORTS MEDICINE PC
Provider Business Mailing Address
First Line : 67 LINCOLN ST
Second Line :
City : ESSEX JUNCTION
State : VT
Zip : 05452-3235
Country : US
Telephone Number : 802-878-1003
Fax Number : 802-878-9966
Provider Business Practice Location Address
First Line : 67 LINCOLN ST
Second Line :
City : ESSEX JUNCTION
State : VT
Zip : 05452-3235
Country : US
Telephone Number : 802-878-1003
Fax Number : 802-878-9966
Authorized Official
Title or Position : OWNER/PHYSICIAN
Name : DR. JOHN RUSSELL JOHANSSON
Credential : DO
Telephone Number : 802-878-1003
Provider Enumeration Date : 02/17/2009
Last Update Date : 06/13/2017

Similar Medicare Providers

1306829312 — MARILYNNE JOHNSON PT
Practice Location Address:
67 LINCOLN ST
ESSEX JUNCTION, VT
05452-3235
Practice Phone: 802-878-9513
Practice Fax: 802-878-9513
1629081187 — ERIKA DIETLINDE SENFT MILLER MSPT. EDD
Practice Location Address:
67 LINCOLN ST
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1316005960 — DR. JOHN RUSSELL JOHANSSON DO
Practice Location Address:
67 LINCOLN ST
ESSEX JUNCTION, VT
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Practice Phone: 802-878-1003
Practice Fax: 802-878-9961
1699806869 — MS. LEONIE BURNS NELSON P.T.
Practice Location Address:
67 LINCOLN ST , CHAMPLAIN PHYSICAL THERAPY
ESSEX JUNCTION, VT
05452-3235
Practice Phone: 802-878-9513
Practice Fax: 802-878-9962
1528273851 — MS. MARY-ELLEN GIROUX M.A.
Practice Location Address:
67 LINCOLN ST
ESSEX JUNCTION, VT
05452-3235
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1609128164 — VERMONT CENTER FOR OCCUPATIONAL REHABILIATION
Practice Location Address:
67 LINCOLN ST
ESSEX JUNCTION, VT
05452-3235
Practice Phone: 802-878-9700
Practice Fax: 802-878-9966

Directions to “CHAMPLAIN SPORTS MEDICINE PC ” Practice Location

Language Start Address Practice Location
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