Healthcare Provider Details

I. General information

NPI: 1184810327
Provider Name (Legal Business Name): RACHEL M JOHNSTON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL M OLSON PT

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S MINNESOTA ST
WARREN MN
56762-1428
US

IV. Provider business mailing address

341 N WEST AVE
WARREN MN
56762-1000
US

V. Phone/Fax

Practice location:
  • Phone: 218-745-3235
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7921
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: