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NPI Code Detail

MEDICARE: KIMBERLY DIANNE JOHNSTON PT

MEDICARE: KIMBERLY DIANNE JOHNSTON PT
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
1225100000XPhysical Therapist6587TN

General Provider Information

NPI Number : 1376622878
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY DIANNE JOHNSTON PT
Provider Business Mailing Address
First Line : 325 RIVERS EDGE DR
Second Line :
City : LOUDON
State : TN
Zip : 37774-5958
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1018 HIGHWAY 321 N
Second Line :
City : LENOIR CITY
State : TN
Zip : 37771-6683
Country : US
Telephone Number : 865-986-5644
Fax Number : 865-986-9109
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2006
Last Update Date : 07/08/2007

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Directions to “ KIMBERLY DIANNE JOHNSTON PT” Practice Location

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