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General NPI Number Information
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NPI Number | 1538011739
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Entity Type | Individual
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Provider Name | MS. JENAE MAYRE JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 02/10/2026
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 1511 US HIGHWAY 59 SE STE A
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City | THIEF RIVER FALLS
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State | MN
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Zip | 56701-3413
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Country | US
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Telephone | 218-681-0449
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 MEADOWLARK CT
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City | THIEF RIVER FALLS
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State | MN
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Zip | 56701-2550
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Country | US
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Telephone | 218-689-6213
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A3123
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License Number State | MN
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