Provider Demographics
NPI:1114928850
Name:JOHNSTON, EMILY (PT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:BEVLAQUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:370 E HERSEY ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2361
Mailing Address - Country:US
Mailing Address - Phone:541-482-6360
Mailing Address - Fax:541-482-6801
Practice Address - Street 1:370 E HERSEY ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2361
Practice Address - Country:US
Practice Address - Phone:541-481-6360
Practice Address - Fax:541-482-6801
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5482225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR141419Medicare PIN