MEDICARE: MR. CRAIG DENNIS JOHNSON P.T

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1974	MN

General Provider Information

NPI Number	:	1811996754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CRAIG DENNIS JOHNSON P.T

Provider Business Mailing Address
First Line	:	7581 9TH ST N
Second Line	:	SUITE 100
City	:	OAKDALE
State	:	MN
Zip	:	55128-6626
Country	:	US
Telephone Number	:	651-748-4338
Fax Number	:	651-748-2892

Provider Business Practice Location Address
First Line	:	730 APOLLO DR
Second Line	:	SUITE 120
City	:	LINO LAKES
State	:	MN
Zip	:	55014-3037
Country	:	US
Telephone Number	:	651-784-7866
Fax Number	:	651-784-7870

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	04/01/2008

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