Provider Demographics
NPI:1053934877
Name:JOHNSON, KAREN MARIE (PT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:MARIE
Other - Last Name:KERSTING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1204 CLOQUET AVE
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-1622
Mailing Address - Country:US
Mailing Address - Phone:218-878-0805
Mailing Address - Fax:218-878-0794
Practice Address - Street 1:1204 CLOQUET AVE
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-1622
Practice Address - Country:US
Practice Address - Phone:218-878-0805
Practice Address - Fax:218-878-0794
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist