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General NPI Number Information
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NPI Number | 1114093572
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Entity Type | Individual
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Provider Name | KRISTINE C JOHNSON PT
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Gender | Female
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 06/18/2020
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Provider Practice Location Address
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Address Line | 120 GRAHAM WAY STE 110
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City | SHELBURNE
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State | VT
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Zip | 05482-7217
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Country | US
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Telephone | 802-657-7990
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Fax |
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Provider Business Mailing Address
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Address Line | 426 INDUSTRIAL AVE SUITE 190
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City | WILLISTON
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State | VT
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Zip | 05495-4448
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Country | US
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Telephone | 802-860-4360
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Fax | 802-488-3160
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0400002908
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License Number State | VT
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