Provider Demographics
NPI:1538628052
Name:JOHNSTON, THOMAS
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15290 HIGHWAY 151
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MO
Mailing Address - Zip Code:65263-2398
Mailing Address - Country:US
Mailing Address - Phone:660-676-8187
Mailing Address - Fax:
Practice Address - Street 1:THRIVE PHYSICAL THERAPY, LLC
Practice Address - Street 2:417 E URBANDALE DRIVE
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270
Practice Address - Country:US
Practice Address - Phone:660-676-8187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-14
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
MO2003000627225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy