MEDICARE: MS. PAMELA ANNE JOHNSON LMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA00004260	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SI3888	OTHER	WA	REGENCE

General Provider Information

NPI Number	:	1205927118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAMELA ANNE JOHNSON LMP

Provider Business Mailing Address
First Line	:	PO BX 236
Second Line	:
City	:	FALL CITY
State	:	WA
Zip	:	98024
Country	:	US
Telephone Number	:	425-222-4118
Fax Number	:

Provider Business Practice Location Address
First Line	:	33605 SE REDMOND FALL CITY RD
Second Line	:	MTN VIEW NUTRITIONAL HEALING CENTRE
City	:	FALL CITY
State	:	WA
Zip	:	98024
Country	:	US
Telephone Number	:	425-222-4118
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	05/07/2009

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