Provider Demographics
NPI:1184216574
Name:JOHNSTON, TRESSA (PT,DPT)
Entity Type:Individual
Prefix:
First Name:TRESSA
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:UT
Mailing Address - Zip Code:84324-4342
Mailing Address - Country:US
Mailing Address - Phone:435-225-0625
Mailing Address - Fax:
Practice Address - Street 1:365 W 1550 N STE H
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-2279
Practice Address - Country:US
Practice Address - Phone:801-618-7903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT286651-24012251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics