Healthcare Provider Details

I. General information

NPI: 1710893318
Provider Name (Legal Business Name): TAQUITA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N SCHROEDER ST APT C-421
BALTIMORE MD
21223-3195
US

IV. Provider business mailing address

PO BOX 13407
BALTIMORE MD
21203-3407
US

V. Phone/Fax

Practice location:
  • Phone: 443-467-2557
  • Fax:
Mailing address:
  • Phone: 443-531-9782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM06446
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: