Provider Demographics
NPI:1275840159
Name:JOHNSTON, AMANDA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5677 OBERLIN DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1740
Mailing Address - Country:US
Mailing Address - Phone:858-457-8419
Mailing Address - Fax:858-457-0670
Practice Address - Street 1:5677 OBERLIN DR
Practice Address - Street 2:SUITE 106
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1740
Practice Address - Country:US
Practice Address - Phone:858-457-8419
Practice Address - Fax:858-457-0670
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT9298225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant