Provider Demographics
NPI:1558397349
Name:JOHNSTON, JANUARY M (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:JANUARY
Middle Name:M
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10700
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502-5517
Mailing Address - Country:US
Mailing Address - Phone:970-241-5856
Mailing Address - Fax:970-241-8599
Practice Address - Street 1:3150 N 12TH ST
Practice Address - Street 2:GARDEN LEVEL
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-2863
Practice Address - Country:US
Practice Address - Phone:970-241-5856
Practice Address - Fax:970-241-8599
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8986225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO840999425012OtherHMO
CO840999425OtherTAX ID
CO840999425OtherTAX ID
COP00270968Medicare ID - Type UnspecifiedRAILROAD