Active NPI
Kevin Neil Johnson, PT,ATC
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- Lakeville, MN
National Provider Identifier
1770806374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- License
- 4901
- Practice address
- 9913 214TH St W Ste B
Lakeville, MN 55044-1914 - Phone
- (952) 985-2020
- NPI assigned
- Mar 10, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Physical Medicine & Rehabilitation) Physician | 2081S0010X | 4901 | MN | Primary |
Addresses
Primary practice location
9913 214TH St W Ste B
Lakeville, MN 55044-1914
Mailing address
9913 214TH St W Ste B
Lakeville, MN 55044-1914
Phone (952) 985-2020
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4901 | MN | MD | Sports Medicine (Physical Medicine & Rehabilitation) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1268179200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268179200000",
"number": "1770806374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9913 214TH ST W STE B",
"city": "LAKEVILLE",
"state": "MN",
"postal_code": "550441914",
"telephone_number": "952-985-2020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9913 214TH ST W STE B",
"city": "LAKEVILLE",
"state": "MN",
"postal_code": "550441914",
"telephone_number": "952-985-2020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "KEVIN",
"middle_name": "NEIL",
"credential": "PT,ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-03-10",
"last_updated": "2010-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "2081S0010X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation, Sports Medicine",
"state": "MN",
"license": "4901",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakeville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.