Basic Information
| Provider Information | |||||||||
| NPI: | 1871894287 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | JOHNSON | ||||||||
| MiddleName: | MARIA FRIEDERIKE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LMP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10316 107TH ST SW | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984981583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533063041 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1175 CENTER DR STE 160 | ||||||||
| Address2: | |||||||||
| City: | DUPONT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983277734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539641559 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2010 | ||||||||
| LastUpdateDate: | 11/16/2010 | ||||||||
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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 | 225700000X | MA60141193 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.