Charles Michael Johnston, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1115228 Issued in TX

Practice address

100 E Ferguson St
Suite 1204
Tyler, TX 75702-5759

Phone

(903) 509-2040

NPI assigned

Sep 17, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1474070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474070400000",
    "number": "1144778234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3710 TERILYNN DR",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756041027",
            "telephone_number": "903-297-5920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E FERGUSON ST",
            "address_2": "SUITE 1204",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757025759",
            "telephone_number": "903-509-2040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSTON",
        "first_name": "CHARLES",
        "middle_name": "MICHAEL",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-09-17",
        "last_updated": "2016-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1115228",
            "primary": true
        },
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "TX",
            "license": "1115228",
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "TX",
            "license": "1115228",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "TX",
            "license": "1115228",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pegan Danielle Johnson, M.S., CCC-SLP
• Roel Mario Johnson, APT
• Shearren Johnson
• Tiffany Johnson
• Tiya Shalyse Johnson, M.D.
• Douglas Frederick Johnston, DO
• Keelie Johnston, PA-C
• Tori Johnston, FNP-C
• Joint Recovery Services LLC
• Jennifer Jolley, LMT

• Physical Therapist in Tyler, TX
• Providers in Tyler, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.