Provider Demographics
NPI:1346634722
Name:JOHNSTON, BEN (LMT)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 MASSILION ST
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:52337-9788
Mailing Address - Country:US
Mailing Address - Phone:319-540-3860
Mailing Address - Fax:
Practice Address - Street 1:300 VIRGIL AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IA
Practice Address - Zip Code:52314-9569
Practice Address - Country:US
Practice Address - Phone:319-895-8655
Practice Address - Fax:319-895-8651
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA006276225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist