Provider Demographics
NPI:1962061275
Name:JOHNSON, KELSEY DAWN (DPT)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:DAWN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 GRAND AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6551
Mailing Address - Country:US
Mailing Address - Phone:406-655-9060
Mailing Address - Fax:406-655-9065
Practice Address - Street 1:3307 GRAND AVE STE 203
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6551
Practice Address - Country:US
Practice Address - Phone:406-655-9060
Practice Address - Fax:406-655-9065
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT17121225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist