Provider Demographics
NPI:1154678324
Name:JOHNSTON, CASEY L (DPT)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:L
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 1:165 ELLSWORTH RD
Mailing Address - Street 2:
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614-5423
Mailing Address - Country:US
Mailing Address - Phone:207-374-7228
Mailing Address - Fax:207-433-1465
Practice Address - Street 1:165 ELLSWORTH RD
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:ME
Practice Address - Zip Code:04614-5423
Practice Address - Country:US
Practice Address - Phone:207-374-7228
Practice Address - Fax:207-433-1465
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist