Provider Demographics
NPI:1023553336
Name:JOHNSTON, SEAN AUSTIN (DPT)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:AUSTIN
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41743 ENTERPRISE CIR N
Mailing Address - Street 2:106
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5645
Mailing Address - Country:US
Mailing Address - Phone:951-302-0278
Mailing Address - Fax:
Practice Address - Street 1:41743 ENTERPRISE CIR N
Practice Address - Street 2:106
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5645
Practice Address - Country:US
Practice Address - Phone:951-302-0278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2925572251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA292557OtherCALIFORNIA DPT LICENSE