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NPI Code Detail

MEDICARE: MARTHA JOHNSTON PTA

MEDICARE: MARTHA JOHNSTON PTA
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
1225200000XPhysical Therapy Assistant5502000187MI

General Provider Information

NPI Number : 1992299572
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTHA JOHNSTON PTA
Provider Business Mailing Address
First Line : 6331 RUSHVIEW DR
Second Line :
City : HUDSONVILLE
State : MI
Zip : 49426-9085
Country : US
Telephone Number : 810-820-0408
Fax Number :
Provider Business Practice Location Address
First Line : 3400 WILSON AVE SW
Second Line :
City : GRANDVILLE
State : MI
Zip : 49418-1854
Country : US
Telephone Number : 616-534-5487
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2018
Last Update Date : 06/18/2018

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