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General NPI Number Information
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NPI Number | 1780676726
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Entity Type | Individual
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Provider Name | DANA ILENE JOHNSON LMP, MMP
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Gender | Female
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11803 101ST AVE CT E STE 100
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City | PUYALLUP
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State | WA
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Zip | 98373-3473
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Country | US
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Telephone | 253-435-1285
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Fax | 253-445-8632
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Provider Business Mailing Address
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Address Line | 25506 157TH AVE SE
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City | COVINGTON
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State | WA
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Zip | 98042-4161
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Country | US
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Telephone | 253-435-1285
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Fax | 253-445-8632
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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 | MA00014833
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License Number State | WA
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