Individual
MARY JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
4600 MONTGOMERY BLVD NE, ALBUQUERQUE, NM 87109-1210
(505) 727-4620
Mailing address
3027 COLONNADE CT NW, ALBUQUERQUE, NM 87107-2961
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
3921
AR
225100000X
Physical Therapist
Primary
4533
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3921
PHYSICAL THERAPY LICENSE
AR
01
—
4533
PHYSICAL THERAPY LICENSE
NM
Enumeration date
09/10/2014
Last updated
09/10/2014
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