Provider Demographics
NPI:1770095481
Name:JOHNSTON, NATHAN CHRISTOPHER
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:CHRISTOPHER
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-2550
Mailing Address - Country:US
Mailing Address - Phone:717-405-9701
Mailing Address - Fax:
Practice Address - Street 1:2000 CAMBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2714
Practice Address - Country:US
Practice Address - Phone:610-775-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE011605225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant