Provider Demographics
NPI:1114123874
Name:JOHNSTON, LEANNE (DPT)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 WILMINGTON DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-6404
Mailing Address - Country:US
Mailing Address - Phone:970-377-1422
Mailing Address - Fax:970-377-1839
Practice Address - Street 1:1939 WILMINGTON DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-6404
Practice Address - Country:US
Practice Address - Phone:970-377-1422
Practice Address - Fax:970-377-1839
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0013226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00472971OtherRETIRED RAILROAD MEDICARE