Provider Demographics
NPI:1922240274
Name:JOHNSON, KELLI (CMT)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 FREMONT AVE S
Mailing Address - Street 2:#401
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2085
Mailing Address - Country:US
Mailing Address - Phone:612-382-6343
Mailing Address - Fax:
Practice Address - Street 1:2935 FREMONT AVE S
Practice Address - Street 2:#401
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2085
Practice Address - Country:US
Practice Address - Phone:612-382-6343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist