Healthcare Provider Details

I. General information

NPI: 1518451004
Provider Name (Legal Business Name): SAMANTHA M JOHNSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA M CROWLEY DPT

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 QUADAY AVE NE
OTSEGO MN
55330-6522
US

IV. Provider business mailing address

3500 AMERICAN BLVD W STE 300
BLOOMINGTON MN
55431-4442
US

V. Phone/Fax

Practice location:
  • Phone: 763-441-0298
  • Fax: 763-441-0591
Mailing address:
  • Phone: 952-512-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11044
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: