Kristine C Johnson, PT
Individual provider Active NPI Physical Therapist · Shelburne, VT
NPI 1114093572 · NPPES record last updated Jun 18, 2020
Key facts
- NPI
- 1114093572
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 0400002908 (VT)
- Practice address
- 120 Graham Way Ste 110
Shelburne, VT 05482-7217 - Phone
- (802) 657-7990
- NPI assigned
- Nov 28, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- PT 360 Inc
Practice addresses (Care Compare)
426 Industrial Ave
Suite 190
Williston, VT 05495-7904
Phone (802) 860-4360
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040317000362 | VT | Practitioner - Physical Therapist in Private Practice | 5193615870 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0400002908 | VT | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| PT 360 Inc | Physical Therapist | Current |
Accepting new patients |
Locations
120 Graham Way
Ste 110
Shelburne, VT 05482
Phone (802) 657-7990
426 Industrial Ave
Ste 190
Williston, VT 05495
Phone (802) 657-7990
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 0400002908 | VT | Yes |
Addresses
Primary practice location
120 Graham Way Ste 110
Shelburne, VT 05482-7217
Mailing address
426 Industrial Ave
Suite 190
Williston, VT 05495-4448
Phone (802) 860-4360
Other practice location 1
426 Industrial Ave
Suite 190
Williston, VT 05495-4448
Phone (802) 860-4360
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 06528521 | Other | BLUE CROSS | |
| 1021737 | Medicaid | VT | |
| 43V402 | Other | MBP |
Other providers in Shelburne, VT
- Integrity Wound Care Plus LLC
- J Adams Psychotherapy and Clinical Counseling Services
- J Adams Psychotherapy and Clinical Counseling Services
- Janet E. Thomason
- Jordan Jensen
- Joyworks, LLC
- Almina Kadric
- Cheryl Karthaus
- Hillary Keating
- Keen Mind Counseling PLC
All providers in Shelburne, VT · Physical Therapist in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 18, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.