MEDICARE: LESLIE JOHNSTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT4574	MS

General Provider Information

NPI Number	:	1831503127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE JOHNSTON

Provider Business Mailing Address
First Line	:	1211 S GLOSTER ST
Second Line	:
City	:	TUPELO
State	:	MS
Zip	:	38801-6546
Country	:	US
Telephone Number	:	662-432-1523
Fax Number	:	662-432-1528

Provider Business Practice Location Address
First Line	:	1211 S GLOSTER ST STE C
Second Line	:
City	:	TUPELO
State	:	MS
Zip	:	38801-6548
Country	:	US
Telephone Number	:	669-432-1523
Fax Number	:	662-432-1528

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2014
Last Update Date	:	08/22/2025

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Directions to “ LESLIE JOHNSTON ” Practice Location

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