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General NPI Number Information
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NPI Number | 1518403708
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Entity Type | Individual
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Provider Name | JAIME LEE JOHNSON LMT, MMP
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Gender | Female
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Dates
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Enumeration Date | 01/11/2017
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Last Update Date | 01/23/2017
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Provider Practice Location Address
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Address Line | 42 BRIDGE ST
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City | EAST WINDSOR
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State | CT
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Zip | 06088-9679
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Country | US
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Telephone | 860-805-9005
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Fax |
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Provider Business Mailing Address
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Address Line | 69 HARRINGTON RD
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City | BROAD BROOK
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State | CT
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Zip | 06016-9613
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Country | US
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Telephone | 860-805-9005
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 005974
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License Number State | CT
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