Provider Demographics
NPI:1225222045
Name:JOHNSTON, MELINDA J (PT)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:J
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:2115 US NH RTE 3
Mailing Address - City:CAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03223-0366
Mailing Address - Country:US
Mailing Address - Phone:603-726-2900
Mailing Address - Fax:603-726-2990
Practice Address - Street 1:2115 US NH ROUTE 3
Practice Address - Street 2:
Practice Address - City:CAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03223-0366
Practice Address - Country:US
Practice Address - Phone:603-726-2900
Practice Address - Fax:603-726-2990
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3096306Medicaid