Provider Demographics
NPI:1023036043
Name:JOHNSON, FILIP LEE (PT)
Entity Type:Individual
Prefix:
First Name:FILIP
Middle Name:LEE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 COUNTY ROAD 120
Mailing Address - Street 2:SUITE A
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303
Mailing Address - Country:US
Mailing Address - Phone:320-259-5429
Mailing Address - Fax:320-240-8905
Practice Address - Street 1:251 COUNTY ROAD 120
Practice Address - Street 2:SUITE A
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-259-5429
Practice Address - Fax:320-240-8905
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7059225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP35412OtherHEALTHPARTNERS
MN298643400Medicaid
MN64-03447OtherMEDICA
MN157T3JOOtherBLUE CROSS BLUE SHIELD
MN264M1NOOtherBLUE CROSS BLUE SHIELD OF MN
MN6403447OtherSELECT CARE
MN650003060Medicare PIN
MNHP35412OtherHEALTHPARTNERS
MN650003061Medicare PIN