Healthcare Provider Details

I. General information

NPI: 1437380201
Provider Name (Legal Business Name): TIFFANY J JOHNSON L.M.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2009
Last Update Date: 08/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14001 E ILIFF AVE STE 111
AURORA CO
80014-1424
US

IV. Provider business mailing address

14001 E ILIFF AVE STE 111
AURORA CO
80014-1424
US

V. Phone/Fax

Practice location:
  • Phone: 303-745-0803
  • Fax: 720-306-3758
Mailing address:
  • Phone: 303-745-0803
  • Fax: 720-306-3758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2284
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: