Provider Demographics
NPI:1235018714
Name:JOHNSTON, KASSIDY LYNN (PTA)
Entity type:Individual
Prefix:MRS
First Name:KASSIDY
Middle Name:LYNN
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:KASSIDY
Other - Middle Name:LYNN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7102 LAWRENCE 1119
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712-6357
Mailing Address - Country:US
Mailing Address - Phone:417-366-4974
Mailing Address - Fax:
Practice Address - Street 1:210 E HALL ST
Practice Address - Street 2:
Practice Address - City:WEBB CITY
Practice Address - State:MO
Practice Address - Zip Code:64870
Practice Address - Country:US
Practice Address - Phone:417-673-6080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025032215225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant