Provider Demographics
NPI:1437341609
Name:JOHNSON, JESSICA LINDSEY (DPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LINDSEY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 LAKEMOOR DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-5307
Mailing Address - Country:US
Mailing Address - Phone:651-436-6883
Mailing Address - Fax:
Practice Address - Street 1:2904 4TH AVE NE
Practice Address - Street 2:SUITE 300
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-7053
Practice Address - Country:US
Practice Address - Phone:253-840-2313
Practice Address - Fax:253-840-6340
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7988225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist