Provider Demographics
NPI:1467423202
Name:JOHNSON, BRETT C (DPT)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:C
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 E SARNIA ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-3803
Mailing Address - Country:US
Mailing Address - Phone:507-474-6900
Mailing Address - Fax:507-474-0502
Practice Address - Street 1:825 NICOLLET MALL STE 1935
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-2707
Practice Address - Country:US
Practice Address - Phone:612-339-2041
Practice Address - Fax:612-339-2042
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7533225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN016688000Medicaid