Healthcare Provider Details

I. General information

NPI: 1437322138
Provider Name (Legal Business Name): MANDI LYNN JOHNSON LMT, ST-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 SW WINTER SPRINGS LN
PORT ORCHARD WA
98367-9318
US

IV. Provider business mailing address

525 SW WINTER SPRINGS LN
PORT ORCHARD WA
98367-9318
US

V. Phone/Fax

Practice location:
  • Phone: 509-432-6506
  • Fax:
Mailing address:
  • Phone: 509-432-6506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License NumberST61607836
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 00019018
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: