Provider Demographics
NPI:1467992404
Name:JOHNSTON, CALEB (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2781 PEOPLES ST APT 304
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-1970
Mailing Address - Country:US
Mailing Address - Phone:276-591-6210
Mailing Address - Fax:
Practice Address - Street 1:101 NETH DR
Practice Address - Street 2:
Practice Address - City:MILLIGAN COLLEGE
Practice Address - State:TN
Practice Address - Zip Code:37682-3015
Practice Address - Country:US
Practice Address - Phone:423-461-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer