Provider Demographics
NPI:1396992418
Name:MJOHNSTON PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:MJOHNSTON PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:603-726-2900
Mailing Address - Street 1:2115 NH US ROUTE 3
Mailing Address - Street 2:
Mailing Address - City:CAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03223
Mailing Address - Country:US
Mailing Address - Phone:603-726-2900
Mailing Address - Fax:603-726-2990
Practice Address - Street 1:2115 NH US ROUTE 3
Practice Address - Street 2:
Practice Address - City:CAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03223
Practice Address - Country:US
Practice Address - Phone:603-726-2900
Practice Address - Fax:603-726-2990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3096305Medicaid