MEDICARE: KRISTIN WAUGH JOHNSON DPT

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	PT018492	PA

General Provider Information

NPI Number	:	1952746760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN WAUGH JOHNSON DPT

Provider Business Mailing Address
First Line	:	1018 S CLEVELAND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-2649
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1018 S CLEVELAND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-2649
Country	:	US
Telephone Number	:	215-478-4332
Fax Number	:

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

Provider Enumeration Date	:	05/07/2013
Last Update Date	:	05/07/2013

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