Healthcare Provider Details

I. General information

NPI: 1982538872
Provider Name (Legal Business Name): ALICIA JOHNSON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11416 S MICHIGAN AVE STE 5
CHICAGO IL
60628-4932
US

IV. Provider business mailing address

11416 S MICHIGAN AVE STE 5
CHICAGO IL
60628-4932
US

V. Phone/Fax

Practice location:
  • Phone: 872-256-2036
  • Fax:
Mailing address:
  • Phone: 872-256-2036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227024190
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: