Healthcare Provider Details

I. General information

NPI: 1679902670
Provider Name (Legal Business Name): JOHANNA KAUFMAN LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOHANNA GARDNER LMP

II. Dates (important events)

Enumeration Date: 11/11/2013
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 WILKES ST
STEILACOOM WA
98388-2122
US

IV. Provider business mailing address

4408 S 9TH ST
TACOMA WA
98405-1210
US

V. Phone/Fax

Practice location:
  • Phone: 253-228-6400
  • Fax:
Mailing address:
  • Phone: 253-228-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 60413850
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: