Provider Demographics
NPI:1538195623
Name:JOHNSON, KRISTIE (DPT)
Entity type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10739 APPALOOSA CT
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-9353
Mailing Address - Country:US
Mailing Address - Phone:303-888-6707
Mailing Address - Fax:
Practice Address - Street 1:5161 E ARAPAHOE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-2387
Practice Address - Country:US
Practice Address - Phone:303-694-6378
Practice Address - Fax:303-694-6379
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9166225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO066515Medicare PIN