Provider Demographics
NPI:1669431193
Name:MENARD-JOHNSTON, ERIN N (DPT)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:N
Last Name:MENARD-JOHNSTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 FOMER RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01073-9663
Mailing Address - Country:US
Mailing Address - Phone:413-219-5547
Mailing Address - Fax:
Practice Address - Street 1:308 FOMER RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01073-9663
Practice Address - Country:US
Practice Address - Phone:413-219-5547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15622225100000X
CT008109225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist