Healthcare Provider Details

I. General information

NPI: 1841704582
Provider Name (Legal Business Name): ROBERTA JEAN JOHNSON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBERTA JEAN JOHNSON LMT

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15200 E GIRARD AVE STE 3100
AURORA CO
80014-5002
US

IV. Provider business mailing address

19593 E 60TH PL
AURORA CO
80019-2185
US

V. Phone/Fax

Practice location:
  • Phone: 720-218-2924
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0012621
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: