Gail I. R. Johnson
Individual provider Active NPI Physical Therapist · Butte Des Morts, WI
NPI 1013074129 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1013074129
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 3701-024 (WI)
- Practice address
- 5121 Washington St.
Butte Des Morts, WI 54927-0346 - Phone
- (920) 540-4808
- NPI assigned
- Jan 2, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3701-024 | WI | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 3701-024 | WI | Yes |
Addresses
Primary practice location
5121 Washington St.
Butte Des Morts, WI 54927-0346
Mailing address
5121 Washington St.
P.O. Box 346
Butte Des Morts, WI 54927-0346
Phone (920) 540-4808
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40294500 | Medicaid | WI |
Other providers in Butte Des Morts, WI
All providers in Butte Des Morts, WI · Physical Therapist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.