Individual
GAIL RENEE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
800 N 1ST ST, SPRINGFIELD, IL 62702-3778
(217) 528-7541
(217) 547-9245
Mailing address
PO BOX 19248, SPRINGFIELD, IL 62794-9248
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070.015476
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00769842
RAILROAD MEDICARE
IL
Enumeration date
03/27/2007
Last updated
12/20/2024
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