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General NPI Number Information
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NPI Number | 1962058784
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Entity Type | Individual
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Provider Name | PATRICE JOHNSON LMT
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Gender | Female
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Dates
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Enumeration Date | 08/16/2019
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Last Update Date | 08/16/2019
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Provider Practice Location Address
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Address Line | 6460 HOLLIS ST STE C
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City | EMERYVILLE
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State | CA
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Zip | 94608-1473
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Country | US
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Telephone | 415-968-1705
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Fax |
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Provider Business Mailing Address
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Address Line | 4019 MOUNT DAY CT
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City | ANTIOCH
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State | CA
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Zip | 94531-8279
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Country | US
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Telephone | 415-609-9635
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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 | 76948
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License Number State | CA
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