Provider Demographics
NPI:1073587457
Name:JOHNSON, JANET LYNNE (ATC/R, MPT)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:LYNNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ATC/R, MPT
Other - Prefix:MRS
Other - First Name:JANET
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1926 JERROLD AVE
Mailing Address - Street 2:
Mailing Address - City:ARDEN HILLS
Mailing Address - State:MN
Mailing Address - Zip Code:55112-7906
Mailing Address - Country:US
Mailing Address - Phone:651-638-6473
Mailing Address - Fax:
Practice Address - Street 1:3900 BETHEL DR
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55112-6902
Practice Address - Country:US
Practice Address - Phone:651-638-6473
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5076390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program