Provider Demographics
NPI:1245842244
Name:JOHNSTON, KYLE (DPT, PT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 POINT BROWN AVE NW
Mailing Address - Street 2:
Mailing Address - City:OCEAN SHORES
Mailing Address - State:WA
Mailing Address - Zip Code:98569-9682
Mailing Address - Country:US
Mailing Address - Phone:360-289-0251
Mailing Address - Fax:
Practice Address - Street 1:885 POINT BROWN AVE NW
Practice Address - Street 2:
Practice Address - City:OCEAN SHORES
Practice Address - State:WA
Practice Address - Zip Code:98569-9682
Practice Address - Country:US
Practice Address - Phone:360-289-0251
Practice Address - Fax:360-289-3226
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61039221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist