MEDICARE: JOANNA CLARICE KAHN 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	60396042401	UT

General Provider Information

NPI Number	:	1528272515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA CLARICE KAHN PT

Provider Business Mailing Address
First Line	:	2174 SUNRISE CIR
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84060-7409
Country	:	US
Telephone Number	:	802-598-6884
Fax Number	:	888-443-1498

Provider Business Practice Location Address
First Line	:	1912 SIDEWINDER DR STE 210A
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84060-7257
Country	:	US
Telephone Number	:	802-598-6884
Fax Number	:	888-443-1498

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	07/07/2023

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