Provider Demographics
NPI:1083672521
Name:JOHNSON, KRISTI M (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11630 STUDT AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7394
Mailing Address - Country:US
Mailing Address - Phone:314-733-9100
Mailing Address - Fax:314-733-9101
Practice Address - Street 1:11630 STUDT AVE STE 200
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7394
Practice Address - Country:US
Practice Address - Phone:314-733-9100
Practice Address - Fax:314-733-9101
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
MO20001745682251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO218123979Medicare ID - Type Unspecified
MO150900024Medicare PIN