Healthcare Provider Details

I. General information

NPI: 1114911682
Provider Name (Legal Business Name): CHRISTOPHER ALLEN JOHNSTON MS, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF SOUTHERN INDIANA 8600 UNIVERSITY BLVD
EVANSVILLE IN
47712
US

IV. Provider business mailing address

2819 LANGSTON DR
EVANSVILLE IN
47725-8081
US

V. Phone/Fax

Practice location:
  • Phone: 812-465-1298
  • Fax: 812-465-7094
Mailing address:
  • Phone: 812-626-5397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36000598A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: