MEDICARE: REBECCA LYNN JOHNSON LMT

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	2020-3801	WV

General Provider Information

NPI Number	:	1912578204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA LYNN JOHNSON LMT

Provider Business Mailing Address
First Line	:	163 RINER AVE
Second Line	:
City	:	OAK HILL
State	:	WV
Zip	:	25901-2652
Country	:	US
Telephone Number	:	304-663-2816
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 MAIN ST W
Second Line	:
City	:	OAK HILL
State	:	WV
Zip	:	25901-2938
Country	:	US
Telephone Number	:	304-663-2816
Fax Number	:

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

Provider Enumeration Date	:	07/07/2021
Last Update Date	:	07/07/2021

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