MEDICARE: SANDY C JOHNSON LMT, MMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT108963	TX

General Provider Information

NPI Number	:	1114258829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDY C JOHNSON LMT, MMP

Provider Business Mailing Address
First Line	:	10014 JOHN RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78015-4739
Country	:	US
Telephone Number	:	830-816-2621
Fax Number	:	830-816-2621

Provider Business Practice Location Address
First Line	:	10014 JOHNS RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78015-4739
Country	:	US
Telephone Number	:	830-816-2621
Fax Number	:	830-816-2621

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2010
Last Update Date	:	06/08/2010

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