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Individual

MR. DEVIN J JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MPT

Contact information

Practice address
516 MONTGOMERY ST, DECORAH, IA 52101-2720
(563) 382-4770
(563) 382-4785
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
03097
IA
2251G0304X
Geriatric Physical Therapist
03097
IA
2251S0007X
Sports Physical Therapist
03097
IA
2251X0800X
Orthopedic Physical Therapist
03097
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
34706
BLUE CROSS BLUE SHEILD
IA
01
36G94JO
BLUE CROSS BLUE SHEILD
MN
01
421470451
MAYO
IA
Enumeration date
06/12/2006
Last updated
04/03/2018
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