Provider Demographics
NPI:1780290049
Name:JOHNSTON, LAUREN MICHELE (PT, DPT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MICHELE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:MICHELE
Other - Last Name:ROSENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:29 GLACIER DR
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2316
Mailing Address - Country:US
Mailing Address - Phone:631-682-5871
Mailing Address - Fax:
Practice Address - Street 1:1800 WALT WHITMAN RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3099
Practice Address - Country:US
Practice Address - Phone:631-694-0005
Practice Address - Fax:631-694-0007
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046159-012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic