Individual
DR. JOHN RUSSELL JOHANSSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
67 LINCOLN ST, ESSEX JUNCTION, VT 05452-3235
(802) 878-1003
(802) 878-9961
Mailing address
67 LINCOLN ST, ESSEX JUNCTION, VT 05452-3235
(802) 878-9278
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
Primary
VT 0000304
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
JOVT-9125
—
VT
Enumeration date
12/05/2006
Last updated
04/18/2017
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