Provider Demographics
NPI:1891922712
Name:JOHNSTON, DANIEL ALAN (PTA)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ALAN
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 1:115 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-2531
Mailing Address - Country:US
Mailing Address - Phone:641-682-8171
Mailing Address - Fax:641-682-9054
Practice Address - Street 1:115 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2531
Practice Address - Country:US
Practice Address - Phone:641-682-8171
Practice Address - Fax:641-682-9054
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001368225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA20-8717967OtherIOWA GROUP TAX ID#
IA0665349Medicaid
IA20-8717967OtherJOHN DEERE HEALTH
IA6-6534OtherBCBS GROUP #
IA16-6534Medicare PIN