Healthcare Provider Details

I. General information

NPI: 1982171211
Provider Name (Legal Business Name): KAITLYN JOHNSTON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 ISLAND BLVD APT D
BOHEMIA NY
11716-4929
US

IV. Provider business mailing address

51 ISLAND BLVD APT D
BOHEMIA NY
11716-4929
US

V. Phone/Fax

Practice location:
  • Phone: 631-402-4508
  • Fax:
Mailing address:
  • Phone: 631-402-4508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: