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General NPI Number Information
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NPI Number | 1437322138
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Entity Type | Individual
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Provider Name | MANDI LYNN JOHNSON LMT, ST-C
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Gender | Female
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 525 SW WINTER SPRINGS LN
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City | PORT ORCHARD
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State | WA
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Zip | 98367-9318
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Country | US
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Telephone | 509-432-6506
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Fax |
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Provider Business Mailing Address
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Address Line | 525 SW WINTER SPRINGS LN
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City | PORT ORCHARD
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State | WA
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Zip | 98367-9318
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Country | US
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Telephone | 509-432-6506
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | ST61607836
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA 00019018
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License Number State | WA
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