Provider Demographics
NPI:1083892277
Name:JOHNSTON, SCOTT (CMT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 COLORADO AVE
Mailing Address - Street 2:UNIT J
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-9005
Mailing Address - Country:US
Mailing Address - Phone:720-771-4061
Mailing Address - Fax:
Practice Address - Street 1:4150 DARLEY AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-6557
Practice Address - Country:US
Practice Address - Phone:720-771-4061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-10
Last Update Date:2008-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist