Provider Demographics
NPI:1770899874
Name:JOHNSTON, JOELLEN (MASSAGE THERAPY)
Entity type:Individual
Prefix:MISS
First Name:JOELLEN
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MASSAGE THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-2542
Mailing Address - Country:US
Mailing Address - Phone:719-680-8031
Mailing Address - Fax:
Practice Address - Street 1:441 UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2542
Practice Address - Country:US
Practice Address - Phone:719-680-8031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8294225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist