Provider Demographics
NPI:1699076240
Name:JOHNSTON, RYAN (LMT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 W 5TH AVE
Mailing Address - Street 2:SUITE 328
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-2962
Mailing Address - Country:US
Mailing Address - Phone:614-216-8832
Mailing Address - Fax:
Practice Address - Street 1:1350 W 5TH AVE
Practice Address - Street 2:SUITE 328
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-2962
Practice Address - Country:US
Practice Address - Phone:614-216-8832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-14
Last Update Date:2010-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33-0171178174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist