Provider Demographics
NPI:1104593730
Name:JOHNSON, KRISTINE ANNA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:ANNA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 LONG BAY LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2777
Mailing Address - Country:US
Mailing Address - Phone:813-476-5351
Mailing Address - Fax:
Practice Address - Street 1:112 AIRPORT BUSINESS PARK DR STE G
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-7453
Practice Address - Country:US
Practice Address - Phone:931-685-8730
Practice Address - Fax:931-685-8736
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist