Healthcare Provider Details

I. General information

NPI: 1154286359
Provider Name (Legal Business Name): WENDY JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 LAKE DR
RIVIERA BEACH FL
33404-3813
US

IV. Provider business mailing address

2633 LAKE DR
RIVIERA BEACH FL
33404-3813
US

V. Phone/Fax

Practice location:
  • Phone: 561-848-5605
  • Fax:
Mailing address:
  • Phone: 561-848-5605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: