Individual
MATTHEW JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1027 WASHINGTON AVE, DETROIT LAKES, MN 56501-3409
(218) 847-5611
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6225
MN
Other
Enumeration date
02/03/2017
Last updated
02/03/2017
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