| Doctor Name: | DR. JOHN RUSSELL JOHANSSON |
| NPI Number: | 1316005960 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DO |
| License Number: | VT 0000304 |
| Business Practice Address: | 67 Lincoln St Essex Junction, VT - 054523235 |
| Business Phone Number: | 8028781003 |
| Business Fax Number: | 8028789961 |
| Mailing Address: | 508 Woods Hollow Rd, WESTFORD |
| State: | VT |
| Postal Code: | 054949774 |
| Phone Number: | 8028789278 |
| Fax Number: | |
| NPI Enumeration Date: | 12/05/2006 |
| NPI Last Update Date: | 08/04/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204C00000X |
| License Number: | VT 0000304 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VT |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Neuromusculoskeletal Medicine, Sports Medicine |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |