Healthcare Provider Details

I. General information

NPI: 1083672521
Provider Name (Legal Business Name): KRISTI M JOHNSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11630 STUDT AVE STE 200
CREVE COEUR MO
63141-7394
US

IV. Provider business mailing address

11630 STUDT AVE STE 200
CREVE COEUR MO
63141-7394
US

V. Phone/Fax

Practice location:
  • Phone: 314-733-9100
  • Fax: 314-733-9101
Mailing address:
  • Phone: 314-733-9100
  • Fax: 314-733-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2000174568
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: