Individual
JENNIFER M JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
207 W FRONT AVE, BISMARCK, ND 58504-5514
(701) 751-0994
(701) 751-1657
Mailing address
207 W FRONT AVE, BISMARCK, ND 58504-5514
(701) 751-0994
(701) 751-1657
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1735
ND
225100000X
Physical Therapist
2237
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
N721104
MEDICARE PTAN
ND
Enumeration date
06/25/2009
Last updated
02/16/2021
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