Provider Demographics
NPI:1598591372
Name:JOHNSTON, JUDITH HELEN (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:HELEN
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 S CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-5114
Mailing Address - Country:US
Mailing Address - Phone:920-285-8041
Mailing Address - Fax:
Practice Address - Street 1:128 S CONCORD AVE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-5114
Practice Address - Country:US
Practice Address - Phone:920-285-8041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3668-146225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty