Provider Demographics
NPI:1023881141
Name:JOHNSTON, ALICE CLAIRE
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:CLAIRE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:CLAIRE
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PARAGON SPORT SPINE & WELLNESS
Mailing Address - Street 2:17 MAIN ST. STE 403
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691
Mailing Address - Country:US
Mailing Address - Phone:609-686-2050
Mailing Address - Fax:609-482-4821
Practice Address - Street 1:PARAGON SPORT SPINE & WELLNESS
Practice Address - Street 2:17 MAIN ST. STE 403
Practice Address - City:ROBBINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08691
Practice Address - Country:US
Practice Address - Phone:609-686-2050
Practice Address - Fax:609-482-4821
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR0113900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist