MEDICARE: MRS. JABRELLIA C JOHNSON LMT

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	14094	SC

General Provider Information

NPI Number	:	1922985381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JABRELLIA C JOHNSON LMT

Provider Business Mailing Address
First Line	:	4853 MEADOWSWEET DR APT 1806
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-6647
Country	:	US
Telephone Number	:	850-542-5432
Fax Number	:

Provider Business Practice Location Address
First Line	:	4853 MEADOWSWEET DR APT 1806
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-6647
Country	:	US
Telephone Number	:	850-542-5432
Fax Number	:

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

Provider Enumeration Date	:	08/18/2025
Last Update Date	:	08/18/2025

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