Individual
KRISTINE C JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
120 GRAHAM WAY STE 110, SHELBURNE, VT 05482-7217
(802) 657-7990
Mailing address
426 INDUSTRIAL AVE, SUITE 190, WILLISTON, VT 05495-4448
(802) 860-4360
(802) 488-3160
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0400002908
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06528521
BLUE CROSS
—
05
—
1021737
—
VT
01
—
43V402
MBP
—
Enumeration date
11/28/2006
Last updated
06/18/2020
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