Provider Demographics
NPI:1477558898
Name:JOHNSTON, BRIAN MACKIE (PT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:MACKIE
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 WOODSTEAD CT
Mailing Address - Street 2:STE 200
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1449
Mailing Address - Country:US
Mailing Address - Phone:281-336-4775
Mailing Address - Fax:281-292-2726
Practice Address - Street 1:1441 WOODSTEAD CT
Practice Address - Street 2:STE 200
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1449
Practice Address - Country:US
Practice Address - Phone:281-336-4775
Practice Address - Fax:281-292-2726
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1079978225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX456669Medicare ID - Type Unspecified