Provider Demographics
NPI:1366404360
Name:JOHNSON, SHANNA K (PT)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:K
Other - Last Name:COLLIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7231 SUNWOOD DRIVE NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303
Mailing Address - Country:US
Mailing Address - Phone:612-863-6029
Mailing Address - Fax:612-863-8942
Practice Address - Street 1:7231 SUNWOOD DRIVE NW
Practice Address - Street 2:SUITE A
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303
Practice Address - Country:US
Practice Address - Phone:612-863-6029
Practice Address - Fax:612-863-8942
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5723225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist