Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 292557 | CA |
NPI | 1023553336 |
---|---|
Provider Name | Sean Austin Johnston |
First Address | Temecula, CA 92590-5645 |
Second Address | Temecula, CA 92590-5645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2016 |
Last Update Date | 21/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
292557 | CALIFORNIA DPT LICENSE (01) | CA |