MEDICARE: MRS. MELINDA G 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	012442-1	NY

General Provider Information

NPI Number	:	1942336953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELINDA G JOHNSON PT

Provider Business Mailing Address
First Line	:	77 NELSON STREET
Second Line	:	SUITE 130
City	:	AUBURN
State	:	NY
Zip	:	13021-1941
Country	:	US
Telephone Number	:	315-253-6891
Fax Number	:	315-255-0873

Provider Business Practice Location Address
First Line	:	77 NELSON STREET
Second Line	:	SUITE 130
City	:	AUBURN
State	:	NY
Zip	:	13021-1941
Country	:	US
Telephone Number	:	315-253-6891
Fax Number	:	315-255-0873

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/18/2008

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