Provider Demographics
NPI:1871260232
Name:JOHNSON, BENJAMIN NORD (CMT)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:NORD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3678 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-8730
Mailing Address - Country:US
Mailing Address - Phone:612-512-9305
Mailing Address - Fax:
Practice Address - Street 1:10904 57TH ST NE
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:MN
Practice Address - Zip Code:55301-4658
Practice Address - Country:US
Practice Address - Phone:612-512-9305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty