Provider Demographics
NPI:1598138067
Name:JOHNSTON, SARA JEAN (LMT)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:JEAN
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 N ORLEANS ST
Mailing Address - Street 2:STE 345
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-3170
Mailing Address - Country:US
Mailing Address - Phone:312-467-0678
Mailing Address - Fax:
Practice Address - Street 1:820 N ORLEANS ST
Practice Address - Street 2:STE 345
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-3170
Practice Address - Country:US
Practice Address - Phone:312-467-0678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.000537225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL227.000537OtherLMT