Healthcare Provider Details

I. General information

NPI: 1225958507
Provider Name (Legal Business Name): KENT DAVID JOHNSON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 NET WAY NW
BEMIDJI MN
56601-5147
US

IV. Provider business mailing address

9353 PONY LAKE RD NW
BEMIDJI MN
56601-7898
US

V. Phone/Fax

Practice location:
  • Phone: 218-333-5504
  • Fax:
Mailing address:
  • Phone: 218-333-5504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9557
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: