Healthcare Provider Details

I. General information

NPI: 1760709075
Provider Name (Legal Business Name): TERA J JOHNSON-SWARTZ CMT, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TERA J JOHNSON CMT, LMT

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

443 S CORONA
DENVER CO
80209
US

IV. Provider business mailing address

443 S CORONA ST
DENVER CO
80209-2413
US

V. Phone/Fax

Practice location:
  • Phone: 615-925-2288
  • Fax:
Mailing address:
  • Phone: 615-925-2288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number879
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number8469
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: