Individual provider Active NPI

Karen Marie Johnson, PT

  • Physical Therapist
  • Cloquet, MN
National Provider Identifier
1053934877
Registry record updated Dec 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
1204 Cloquet Ave
Cloquet, MN 55720-1622
Phone
(218) 878-0805
Fax
(218) 878-0794
NPI assigned
May 27, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

1204 Cloquet Ave
Cloquet, MN 55720-1622

Mailing address

1204 Cloquet Ave
Cloquet, MN 55720-1622
Phone (218) 878-0805

Other practice location 1

300 S Bruce St
Marshall, MN 56258-1934
Phone (507) 537-9172

Other names 1

  • Karen Marie Kersting Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250131000103 MN Practitioner - Physical Therapist in Private Practice 0244769503 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Park Avenue Therapies Physical Therapist CurrentSince Dec 19, 2024 Accepting new patients

Locations

1204 Cloquet Ave
Cloquet, MN 55720
Phone (218) 878-0805

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1590537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734480000000",
    "number": "1053934877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1204 CLOQUET AVE",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557201622",
            "telephone_number": "218-878-0805",
            "fax_number": "218-878-0794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 CLOQUET AVE",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557201622",
            "telephone_number": "218-878-0805",
            "fax_number": "218-878-0794"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 S Bruce St",
            "address_purpose": "LOCATION",
            "city": "Marshall",
            "state": "MN",
            "postal_code": "562581934",
            "country_code": "US",
            "telephone_number": "507-537-9172",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KAREN",
        "middle_name": "MARIE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-27",
        "last_updated": "2024-12-18",
        "certification_date": "2024-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAREN",
            "last_name": "KERSTING",
            "middle_name": "MARIE",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Cloquet, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.