Healthcare Provider Details

I. General information

NPI: 1245842244
Provider Name (Legal Business Name): KYLE JOHNSTON DPT, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 03/07/2021
Certification Date: 03/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 POINT BROWN AVE NW
OCEAN SHORES WA
98569-9682
US

IV. Provider business mailing address

885 POINT BROWN AVE NW
OCEAN SHORES WA
98569-9682
US

V. Phone/Fax

Practice location:
  • Phone: 360-289-0251
  • Fax: 360-289-3226
Mailing address:
  • Phone: 360-289-0251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT61039221
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: