Individual
KYLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
9675 E ELM RD, POPLAR, WI 54864-9102
(715) 364-8565
Mailing address
1000 MIDWAY RD, MENASHA, WI 54952-1116
(920) 257-2006
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
15548-24
WI
Other
Enumeration date
07/26/2021
Last updated
07/26/2021
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