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General NPI Number Information
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NPI Number | 1235018714
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Entity Type | Individual
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Provider Name | KASSIDY LYNN JOHNSTON PTA
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Gender | Female
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Dates
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Enumeration Date | 08/29/2025
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 210 E HALL ST
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City | WEBB CITY
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State | MO
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Zip | 64870
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Country | US
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Telephone | 417-673-6080
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Fax |
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Provider Business Mailing Address
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Address Line | 7102 LAWRENCE 1119
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City | MOUNT VERNON
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State | MO
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Zip | 65712-6357
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Country | US
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Telephone | 417-366-4974
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2025032215
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License Number State | MO
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