MEDICARE: DONNA P JOHNSON PHYSICAL THERAPY 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
1	225100000X	Physical Therapist	0400002348	VT

General Provider Information

NPI Number	:	1790162212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONNA P JOHNSON PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	28 4TH ST
Second Line	:
City	:	FAIR HAVEN
State	:	VT
Zip	:	05743-1053
Country	:	US
Telephone Number	:	802-265-4055
Fax Number	:	802-265-8838

Provider Business Practice Location Address
First Line	:	28 4TH ST
Second Line	:
City	:	FAIR HAVEN
State	:	VT
Zip	:	05743-1053
Country	:	US
Telephone Number	:	802-265-4055
Fax Number	:	802-265-8838

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DONNA F PLANTE
Credential	:	PT
Telephone Number	:	802-265-4055

Provider Enumeration Date	:	05/05/2015
Last Update Date	:	05/05/2015

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