Provider Demographics
NPI:1891727137
Name:JOHNSTON, DANIEL MORGAN (PT, OCS, CSCS, CMP)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:MORGAN
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:PT, OCS, CSCS, CMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 PASEO CAMARILLO # 105
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-5900
Mailing Address - Country:US
Mailing Address - Phone:805-987-6851
Mailing Address - Fax:805-987-8045
Practice Address - Street 1:500 PASEO CAMARILLO # 105
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-5900
Practice Address - Country:US
Practice Address - Phone:805-987-6851
Practice Address - Fax:805-987-8045
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT28530AMedicare ID - Type Unspecified
CABH695ZMedicare PIN