Provider Demographics
NPI:1770186678
Name:JOHNSTON, MOLLIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W 98TH ST STE 390
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55420-4792
Mailing Address - Country:US
Mailing Address - Phone:952-469-4900
Mailing Address - Fax:
Practice Address - Street 1:600 W 98TH ST STE 390
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55420-4792
Practice Address - Country:US
Practice Address - Phone:952-460-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-21
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA100945225100000X
MN13807225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist