Healthcare Provider Details

I. General information

NPI: 1972435261
Provider Name (Legal Business Name): BRIANNA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29429 455TH AVE
IRENE SD
57037-6610
US

IV. Provider business mailing address

29429 455TH AVE
IRENE SD
57037-6610
US

V. Phone/Fax

Practice location:
  • Phone: 605-744-9016
  • Fax:
Mailing address:
  • Phone: 605-744-9016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP058530T
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6279
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: