Provider Demographics
NPI:1134111800
Name:JOHNSTON, CAROL G (PTDPT, OCS)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:G
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PTDPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 S ALABAMA AVE
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36460-2507
Mailing Address - Country:US
Mailing Address - Phone:251-575-5755
Mailing Address - Fax:888-505-2923
Practice Address - Street 1:809 S ALABAMA AVE
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36460-2507
Practice Address - Country:US
Practice Address - Phone:251-575-5755
Practice Address - Fax:888-505-2923
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2389225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051515575JOHMedicare ID - Type Unspecified
ALP89882Medicare UPIN