Healthcare Provider Details

I. General information

NPI: 1225967854
Provider Name (Legal Business Name): CASIE BREANNA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 BROWNS MILL RD BLDG D
JOHNSON CITY TN
37604-1910
US

IV. Provider business mailing address

1105 ANTIOCH RD
JOHNSON CITY TN
37604-6379
US

V. Phone/Fax

Practice location:
  • Phone: 423-948-2496
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14770
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: