Healthcare Provider Details

I. General information

NPI: 1902377120
Provider Name (Legal Business Name): MORGAN LEE JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE
SEATTLE WA
98104-2420
US

IV. Provider business mailing address

1959 NE PACIFIC ST BOX # 356154
SEATTLE WA
98195-6154
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-9887
  • Fax: 206-744-9390
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: