Healthcare Provider Details

I. General information

NPI: 1457561367
Provider Name (Legal Business Name): LEAH S JOHNSON MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5808 MCLEOD RD NE SUITE J
ALBUQUERQUE NM
87109-2455
US

IV. Provider business mailing address

4317 SAN PEDRO DR NE APT A14
ALBUQUERQUE NM
87109-7120
US

V. Phone/Fax

Practice location:
  • Phone: 505-889-3044
  • Fax:
Mailing address:
  • Phone: 505-889-3044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number501
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: