=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962368035
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEIKO JOHNSON MT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/01/2026
-----------------------------------------------------
Last Update Date | 01/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1120 W SOUTH BOULDER RD STE 101C
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80026-8952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-226-0599
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1261 E 135TH PL
-----------------------------------------------------
City | THORNTON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80241-1991
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-280-0806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT.0026658
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT.9438
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------