Individual
MR. SHELLEY DALE JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
301 4TH ST, LA GRANDE, OR 97850-1901
(541) 963-9340
(541) 963-4562
Mailing address
301 4TH ST, LA GRANDE, OR 97850-1901
(541) 963-9340
(541) 963-4562
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
0557
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
152140
—
OR
01
—
838502000
RBCBSO
OR
01
—
P00233908
RR MEDICARE
OR
Enumeration date
05/10/2006
Last updated
07/02/2014
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