Healthcare Provider Details

I. General information

NPI: 1235343260
Provider Name (Legal Business Name): CHRISTY L. JOHNSON-NEAL LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 MERLE HAY RD
JOHNSTON IA
50131-1444
US

IV. Provider business mailing address

PO BOX 7
INDIANOLA IA
50125-0007
US

V. Phone/Fax

Practice location:
  • Phone: 515-745-2488
  • Fax:
Mailing address:
  • Phone: 515-745-2488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number04301
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00017195
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11465
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: