Provider Demographics
NPI:1649815812
Name:JOHNSON, KRISTEN (PT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 N WINSTEL BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-3329
Mailing Address - Country:US
Mailing Address - Phone:216-308-0438
Mailing Address - Fax:
Practice Address - Street 1:8703 E GOLF LINKS RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85730-1301
Practice Address - Country:US
Practice Address - Phone:520-514-1114
Practice Address - Fax:520-514-2144
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist