MEDICARE: MS. DEANN RACHEL JOHNSON 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	MT 1213	MT

General Provider Information

NPI Number	:	1861585606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEANN RACHEL JOHNSON PT

Provider Business Mailing Address
First Line	:	825 SAGEBRUSH LN STE 1
Second Line	:
City	:	DEER LODGE
State	:	MT
Zip	:	59722-2320
Country	:	US
Telephone Number	:	406-846-7770
Fax Number	:	406-846-7771

Provider Business Practice Location Address
First Line	:	124 OAK ST
Second Line	:
City	:	ANACONDA
State	:	MT
Zip	:	59711-2335
Country	:	US
Telephone Number	:	406-846-7770
Fax Number	:	406-846-7771

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	08/16/2019

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