Individual
LORI JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
344 5TH AVE S, SOUTH ST PAUL, MN 55075-2619
(612) 402-4688
Mailing address
344 5TH AVE S, SOUTH SAINT PAUL, MN 55075-2619
(612) 402-4688
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A686
MN
Other
Enumeration date
11/04/2015
Last updated
11/04/2015
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