Provider Demographics
NPI:1558135103
Name:JOHNSTIN, AMBER MARIE (CMT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:JOHNSTIN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:M
Other - Last Name:JACOBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 SMITH AVE S
Mailing Address - Street 2:
Mailing Address - City:WEST ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-2068
Mailing Address - Country:US
Mailing Address - Phone:651-755-8980
Mailing Address - Fax:
Practice Address - Street 1:776 N PLAZA DR
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55120-1509
Practice Address - Country:US
Practice Address - Phone:651-964-3446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist