Provider Demographics
NPI:1902803281
Name:DONNA P JOHNSON PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:DONNA P JOHNSON PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:F
Authorized Official - Last Name:PLANTE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:802-265-4055
Mailing Address - Street 1:28 4TH ST
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:VT
Mailing Address - Zip Code:05743-1053
Mailing Address - Country:US
Mailing Address - Phone:802-265-4055
Mailing Address - Fax:802-265-4055
Practice Address - Street 1:5 MADISON ST
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:NY
Practice Address - Zip Code:12832-1209
Practice Address - Country:US
Practice Address - Phone:802-265-4055
Practice Address - Fax:802-265-4055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2506Medicaid
NYAA0299Medicare ID - Type UnspecifiedUPSTATE MEDICARE DIVISION
NY=========OtherVARIOUS MANAGED CARE COMP
VTVN2506Medicare ID - Type UnspecifiedNHIC