MEDICARE: MRS. MEGAN MARIE JOHNSON LPTA

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	225200000X	Physical Therapy Assistant	PTA 05548	OH

General Provider Information

NPI Number	:	1780815787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEGAN MARIE JOHNSON LPTA

Provider Business Mailing Address
First Line	:	2593 US HIGHWAY 6
Second Line	:
City	:	MC CLURE
State	:	OH
Zip	:	43534-9730
Country	:	US
Telephone Number	:	419-748-8306
Fax Number	:

Provider Business Practice Location Address
First Line	:	2593 US HIGHWAY 6
Second Line	:
City	:	MC CLURE
State	:	OH
Zip	:	43534-9730
Country	:	US
Telephone Number	:	419-748-8306
Fax Number	:

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

Provider Enumeration Date	:	08/07/2009
Last Update Date	:	08/07/2009

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