Provider Demographics
NPI:1811996754
Name:JOHNSON, CRAIG DENNIS (PT)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:DENNIS
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7581 9TH ST N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-6626
Mailing Address - Country:US
Mailing Address - Phone:651-748-4338
Mailing Address - Fax:651-748-2892
Practice Address - Street 1:730 APOLLO DR
Practice Address - Street 2:SUITE 120
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55014-3037
Practice Address - Country:US
Practice Address - Phone:651-784-7866
Practice Address - Fax:651-784-7870
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1974225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist