Provider Demographics
NPI:1598296733
Name:MOMSEN-JOHNSON, ELISA (DPT)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:MOMSEN-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 1:11091 JASON AVE NW
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ALBERTVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:73055
Mailing Address - Country:US
Mailing Address - Phone:763-744-4148
Mailing Address - Fax:763-497-0679
Practice Address - Street 1:11091 JASON AVE NW
Practice Address - Street 2:SUITE 2
Practice Address - City:ALBERTVILLE
Practice Address - State:MN
Practice Address - Zip Code:73055
Practice Address - Country:US
Practice Address - Phone:763-744-4148
Practice Address - Fax:763-497-0679
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8335225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist