Individual
CHAD BENJAMIN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
915 E 1ST ST, DULUTH, MN 55805-2107
(218) 249-5555
Mailing address
915 E 1ST ST, DULUTH, MN 55805-2107
(218) 249-5555
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12211
WI
225100000X
Physical Therapist
7920
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12211
STATE LICENSE
WI
01
—
7920
MN LICENSE
MN
Enumeration date
08/09/2007
Last updated
04/13/2021
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