Provider Demographics
NPI:1437383858
Name:JOHNSTON, JESSICA M (PT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
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 1:49050 SCHOENHERR RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-3856
Mailing Address - Country:US
Mailing Address - Phone:586-566-8913
Mailing Address - Fax:586-566-8379
Practice Address - Street 1:49050 SCHOENHERR RD
Practice Address - Street 2:SUITE 600
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-3856
Practice Address - Country:US
Practice Address - Phone:586-566-8913
Practice Address - Fax:586-566-8379
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist