Individual
JENNIFER M. JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
315 N MILWAUKEE ST, WATERFORD, WI 53185-4432
(262) 514-2700
(262) 514-3003
Mailing address
3915 30TH AVE, KENOSHA, WI 53144-1957
(262) 657-0222
(262) 657-7190
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10136-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
859400066
MEDICARE
WI
Enumeration date
09/24/2006
Last updated
10/31/2011
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