Provider Demographics
NPI:1467985770
Name:JOHNSON, HANNAH ELEANOR (DPT)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:ELEANOR
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 1:1894 37TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56304-9508
Mailing Address - Country:US
Mailing Address - Phone:320-227-2606
Mailing Address - Fax:320-227-2607
Practice Address - Street 1:11 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04654-3325
Practice Address - Country:US
Practice Address - Phone:207-255-3356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62948225100000X
MN10557225100000X
MEPT4983225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist