Individual
MALCOLM A JOHNSTON IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
133 N RIVER ST, WILKES BARRE, PA 18711-0800
(570) 208-5900
Mailing address
133 N RIVER ST, WILKES BARRE, PA 18711-0800
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
PA
Other
Enumeration date
09/11/2017
Last updated
09/11/2017
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