MEDICARE: MRS. VICKY JOHNSON P.T.

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	2251X0800X	Orthopedic Physical Therapist	4651	CO

General Provider Information

NPI Number	:	1891857793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICKY JOHNSON P.T.

Provider Business Mailing Address
First Line	:	43449 ELK RUN
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-9115
Country	:	US
Telephone Number	:	970-870-8991
Fax Number	:	970-870-0932

Provider Business Practice Location Address
First Line	:	1856 LINCOLN AVE
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-5046
Country	:	US
Telephone Number	:	970-879-4558
Fax Number	:	970-870-8099

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

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	07/08/2007

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