Provider Demographics
NPI:1568789642
Name:JOHNSTON, ALEXANDRA MARIE (CMT)
Entity Type:Individual
Prefix:MISS
First Name:ALEXANDRA
Middle Name:MARIE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5455 W 38TH AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80212-7068
Mailing Address - Country:US
Mailing Address - Phone:720-227-6522
Mailing Address - Fax:
Practice Address - Street 1:1880 S PIERCE ST STE 14
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-7143
Practice Address - Country:US
Practice Address - Phone:303-763-8433
Practice Address - Fax:303-936-0705
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0005715225700000X
CO5715173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist