Provider Demographics
NPI:1649490681
Name:JOHNSTON, JOHN JOSEPH (PT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ARTHUR MATTHEW DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-2802
Mailing Address - Country:US
Mailing Address - Phone:781-826-7006
Mailing Address - Fax:781-659-4970
Practice Address - Street 1:306 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1704
Practice Address - Country:US
Practice Address - Phone:781-659-7937
Practice Address - Fax:781-659-4970
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY65978Medicaid
MAY65978Medicaid