Provider Demographics
NPI:1801248158
Name:JOHNSTON, SUSAN (BCTMB LMT CMT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:BCTMB LMT CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4234 N WINFIELD SCOTT PLZ
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3944
Mailing Address - Country:US
Mailing Address - Phone:480-366-4000
Mailing Address - Fax:
Practice Address - Street 1:4234 N WINFIELD SCOTT PLZ
Practice Address - Street 2:SUITE 108
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3944
Practice Address - Country:US
Practice Address - Phone:480-366-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-14430173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist