Provider Demographics
NPI:1679663470
Name:JOHNSTON, LINDA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 N 40TH ST STE 252
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2191
Mailing Address - Country:US
Mailing Address - Phone:602-956-9434
Mailing Address - Fax:
Practice Address - Street 1:5110 N 40TH ST STE 252
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2191
Practice Address - Country:US
Practice Address - Phone:602-956-9434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1239225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ78750Medicare ID - Type Unspecified