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General NPI Number Information
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NPI Number | 1750872461
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Entity Type | Individual
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Provider Name | HAIDEN JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 05/29/2018
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Last Update Date | 05/29/2018
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Provider Practice Location Address
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Address Line | 916 NE 65TH ST
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City | SEATTLE
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State | WA
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Zip | 98115-5542
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Country | US
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Telephone | 206-267-0863
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Fax |
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Provider Business Mailing Address
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Address Line | 1821 NELSON SIDING RD
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City | CLE ELUM
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State | WA
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Zip | 98922-9478
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Country | US
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Telephone | 425-830-6061
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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 | MA60853972
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License Number State | WA
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