Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | ||
Y | 2251X0800X | Physical Therapist - Orthopedic | 2000174568 | MO |
NPI | 1083672521 |
---|---|
Provider Name | Mrs. Kristi M Johnson |
First Address | Creve Coeur, MO 63141-7394 |
Second Address | Creve Coeur, MO 63141-7394 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 28/02/2020 |