Provider Demographics
NPI:1033329339
Name:JOHNSON, KRISTIN LEE (PT, DPT, NCS)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:LEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT, DPT, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4602
Mailing Address - Country:US
Mailing Address - Phone:952-993-5495
Mailing Address - Fax:
Practice Address - Street 1:6701 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4602
Practice Address - Country:US
Practice Address - Phone:952-993-5495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2932225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist