Provider Demographics
NPI:1558306936
Name:JOHNELMS LLC
Entity Type:Organization
Organization Name:JOHNELMS LLC
Other - Org Name:CHOICE PHYSICAL THERAPY OF PLYMOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FORTUNATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-434-9398
Mailing Address - Street 1:790 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:NH
Mailing Address - Zip Code:03222-4548
Mailing Address - Country:US
Mailing Address - Phone:603-744-0275
Mailing Address - Fax:603-744-9378
Practice Address - Street 1:790 LAKE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:NH
Practice Address - Zip Code:03222-4548
Practice Address - Country:US
Practice Address - Phone:603-744-0275
Practice Address - Fax:603-744-9378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2011-02-14
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
DD2778OtherRAILROAD MEDICARE
VTCHOI59439OtherVT BLUE CROSS
DD2778OtherRAILROAD MEDICARE