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NPI Code Detail

MEDICARE: BONNIE LEE JOHNSON PTA

MEDICARE: BONNIE LEE JOHNSON PTA
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
1225200000XPhysical Therapy Assistant5502001091MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669788097
Entity Type Code : Individual
Provider Name (Legal Business Name) : BONNIE LEE JOHNSON PTA
Provider Business Mailing Address
First Line : PO BOX 639
Second Line :
City : THIENSVILLE
State : WI
Zip : 53092-0639
Country : US
Telephone Number : 414-247-9005
Fax Number : 414-247-9004
Provider Business Practice Location Address
First Line : 7235 W APPLETON AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53216-1932
Country : US
Telephone Number : 414-815-6700
Fax Number : 414-755-1434
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2010
Last Update Date : 08/14/2014

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