Provider Demographics
NPI:1902269681
Name:JOHNSON, KRISTA (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:E
Other - Last Name:SCNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8889 W 75TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2206
Mailing Address - Country:US
Mailing Address - Phone:913-322-7828
Mailing Address - Fax:913-319-8904
Practice Address - Street 1:8889 W 75TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-2206
Practice Address - Country:US
Practice Address - Phone:913-322-7828
Practice Address - Fax:913-319-8904
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-05284225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201222760AMedicaid