Provider Demographics
NPI:1275575300
Name:JOHNSON, LORIANN M (PT)
Entity Type:Individual
Prefix:
First Name:LORIANN
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 1:520 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAWLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56549-4726
Mailing Address - Country:US
Mailing Address - Phone:218-483-1500
Mailing Address - Fax:218-483-1501
Practice Address - Street 1:520 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAWLEY
Practice Address - State:MN
Practice Address - Zip Code:56549-4726
Practice Address - Country:US
Practice Address - Phone:218-483-1500
Practice Address - Fax:218-483-1501
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1044225100000X
MN7264225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND54862Medicaid
MN874633800Medicaid
MN874633800Medicaid
ND24332Medicare ID - Type Unspecified