1619963766 NPI number — LORI L JOHNSON PT, CLT

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619963766 NPI number — LORI L JOHNSON PT, CLT

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

JOHNSON

Provider First Name:

LORI

Provider Middle Name:

L

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

PT, CLT

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

JORGENSEN

Provider Other First Name:

LORI

Provider Other Middle Name:

L

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

1

NPI Number:

1619963766

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1720 S CLIFF AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SIOUX FALLS

Provider Business Mailing Address State Name:

SD

Provider Business Mailing Address Postal Code:

57105-2129

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

605-334-5630

Provider Business Mailing Address Fax Number:

605-332-5327

Provider First Line Business Practice Location Address:

1720 S CLIFF AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SIOUX FALLS

Provider Business Practice Location Address State Name:

SD

Provider Business Practice Location Address Postal Code:

57105-2129

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

605-334-5630

Provider Business Practice Location Address Fax Number:

605-332-5327

Provider Enumeration Date:

09/23/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 225100000X , with the licence number:  1157 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 225100000X , with the licence number: 03352 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 225100000X , with the licence number: 6924 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 244T0JO . This is a "BLUE CROSS BLUE SHIELD MN" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 5833743 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
• Identifier: 5833744 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
• Identifier: 64-02620 . This is a "MEDICA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: PT1157 . This is a "DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 4994827 . This is a "BLUE CROSS BLUE SHIELD SD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 4996128 . This is a "BLUE CROSS BLUE SHEILD SD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 596287 . This is a "ARAZ" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 64-04051 . This is a "MEDICA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 5833740 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
• Identifier: 64-03738 . This is a "MEDICA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 64-05327 . This is a "MEDICA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 20874 . This is a "SIOUX VALLEY HEALTH PLAN" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 4997067 . This is a "BLUE CROSS BLUE SHIELD SD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 5833742 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".