Provider Demographics
NPI:1407498215
Name:JOHNSTON, KINSEY ELLEN (LMT)
Entity Type:Individual
Prefix:
First Name:KINSEY
Middle Name:ELLEN
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KINSEY
Other - Middle Name:ELLEN
Other - Last Name:BENZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2707 KEYSTONE LANE APT 202
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180
Mailing Address - Country:US
Mailing Address - Phone:720-985-3285
Mailing Address - Fax:
Practice Address - Street 1:1401 N ADAMS ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201
Practice Address - Country:US
Practice Address - Phone:703-465-1213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019015320225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist