Provider Demographics
NPI:1427254382
Name:JOHNSON, KATHY ANN (PT)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N MILL ST
Mailing Address - Street 2:
Mailing Address - City:LAKE MILLS
Mailing Address - State:IA
Mailing Address - Zip Code:50450-1303
Mailing Address - Country:US
Mailing Address - Phone:641-592-3500
Mailing Address - Fax:
Practice Address - Street 1:115 N MILL ST
Practice Address - Street 2:
Practice Address - City:LAKE MILLS
Practice Address - State:IA
Practice Address - Zip Code:50450-1303
Practice Address - Country:US
Practice Address - Phone:641-592-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND0495225100000X
IA005034225100000X
MN2457225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist