Healthcare Provider Details

I. General information

NPI: 1467979013
Provider Name (Legal Business Name): BRIAN R JOHNSON JR. LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 SW 160TH ST STE 201
BURIEN WA
98166-3003
US

IV. Provider business mailing address

275 SW 160TH ST STE 201
BURIEN WA
98166-3003
US

V. Phone/Fax

Practice location:
  • Phone: 206-244-4263
  • Fax: 206-244-4263
Mailing address:
  • Phone: 206-244-4263
  • Fax: 206-244-8703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60788102
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: