Healthcare Provider Details

I. General information

NPI: 1629940077
Provider Name (Legal Business Name): ABIGAIL J JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 23RD AVE E STE 103
WEST FARGO ND
58078-7402
US

IV. Provider business mailing address

1420 9TH ST E STE 401
WEST FARGO ND
58078-3381
US

V. Phone/Fax

Practice location:
  • Phone: 701-639-2769
  • Fax:
Mailing address:
  • Phone: 701-364-2739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2956
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: