Provider Demographics
NPI:1366956161
Name:JOHNSTON, AMANDA LYNN (DPT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 JACKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1801
Mailing Address - Country:US
Mailing Address - Phone:210-256-0700
Mailing Address - Fax:210-256-0702
Practice Address - Street 1:5310 JACKWOOD DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1801
Practice Address - Country:US
Practice Address - Phone:210-256-0700
Practice Address - Fax:210-256-0702
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1299423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist