Individual
JILL KRISTA JOHANNSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
1122
SD
225100000X
Physical Therapist
Primary
1122
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
393065300
—
MN
05
—
46030609213
—
NE
05
—
6402180
—
SD
Enumeration date
03/29/2006
Last updated
11/25/2019
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