Provider Demographics
NPI:1629128129
Name:JOHNSTON, PAUL F (PTA)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:F
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 E TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU CHIEN
Mailing Address - State:WI
Mailing Address - Zip Code:53821-2110
Mailing Address - Country:US
Mailing Address - Phone:608-357-2000
Mailing Address - Fax:608-357-2254
Practice Address - Street 1:705 E TAYLOR ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU CHIEN
Practice Address - State:WI
Practice Address - Zip Code:53821-2110
Practice Address - Country:US
Practice Address - Phone:608-357-2000
Practice Address - Fax:608-357-2254
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI328019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40368900Medicaid