Basic Information
| Provider Information | |||||||||
| NPI: | 1184840936 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | Q. | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4631 WHITMAN LN SE | ||||||||
| Address2: | STE D | ||||||||
| City: | LACEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985132250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604582444 | ||||||||
| FaxNumber: | 3604582747 | ||||||||
| Practice Location | |||||||||
| Address1: | 417 W YELM AVE | ||||||||
| Address2: | |||||||||
| City: | YELM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985977679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604582444 | ||||||||
| FaxNumber: | 3604582747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 10/12/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT00009980 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0239385 | 01 | WA | DEPT L&I | OTHER | 1651QU | 01 | WA | REGENCE | OTHER | 5210QU | 01 | WA | REGENCE | OTHER | 3600QQU | 01 | WA | REGENCE | OTHER | 8522641 | 01 | WA | DSHS | OTHER | 7085QU | 01 | WA | REGENCE | OTHER | 6981QU | 01 | WA | REGENCE | OTHER |