Provider Demographics
NPI:1760892780
Name:JOHNSON, LINDSEY (RPT)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:MN
Mailing Address - Zip Code:55005-0136
Mailing Address - Country:US
Mailing Address - Phone:763-753-8804
Mailing Address - Fax:763-753-7928
Practice Address - Street 1:3220 BRIDGE ST
Practice Address - Street 2:SUITE 111
Practice Address - City:ST. FRANCIS
Practice Address - State:MN
Practice Address - Zip Code:55070
Practice Address - Country:US
Practice Address - Phone:763-753-8804
Practice Address - Fax:763-753-7928
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN9316225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist