Provider Demographics
NPI:1083910053
Name:JOHNSTON, DANA ANNE (MS, ATC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:ANNE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 N SHORE RD
Mailing Address - Street 2:
Mailing Address - City:PUTNAM VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10579-1521
Mailing Address - Country:US
Mailing Address - Phone:845-661-5838
Mailing Address - Fax:845-938-6297
Practice Address - Street 1:35 N SHORE RD
Practice Address - Street 2:
Practice Address - City:PUTNAM VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10579-1521
Practice Address - Country:US
Practice Address - Phone:845-661-5838
Practice Address - Fax:845-938-6297
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001985-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer