Healthcare Provider Details

I. General information

NPI: 1992058010
Provider Name (Legal Business Name): ELIZABETH M JOHNSEN LMT,CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2012
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 C MAIN ST
FRISCO CO
80443
US

IV. Provider business mailing address

PO BOX 809 507 MAIN ST C
FRISCO CO
80443-0809
US

V. Phone/Fax

Practice location:
  • Phone: 970-668-8155
  • Fax: 970-668-1301
Mailing address:
  • Phone: 970-668-8155
  • Fax: 970-668-1301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number4640
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: