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General NPI Number Information
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NPI Number | 1548836364
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Entity Type | Individual
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Provider Name | DANIEL JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 06/02/2021
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 490 LYNNHURST AVE E
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City | SAINT PAUL
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State | MN
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Zip | 55104-3406
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Country | US
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Telephone | 651-353-0316
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 CAMBRIDGE ST APT 310
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City | HOPKINS
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State | MN
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Zip | 55343-1921
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Country | US
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Telephone | 651-353-0316
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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 | A2670
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License Number State | MN
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