Organization
MICHAEL JOHNSTON LLC
Active
Other names
FUNdamental Pediatric Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BAGLEY JOHNSTON (SPEECH THERAPIST/OWNER)
(318) 515-1488
Entity
Organization
Contact information
Practice address
128 DIANE LANE SUITE 4, STONEWALL, LA 71078-9421
(318) 564-2171
Mailing address
212 PANTHER DR, STONEWALL, LA 71078-9421
(318) 564-2171
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
02/18/2022
Last updated
04/01/2022
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