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NPI Code Detail

MEDICARE: MARY K JOHNSON LMP

MEDICARE: MARY K JOHNSON LMP
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
1225700000XMassage TherapistMA60117438WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10257710OTHERWAL&I

General Provider Information

NPI Number : 1972831923
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY K JOHNSON LMP
Provider Business Mailing Address
First Line : 1519 132ND ST SE
Second Line : SUITE A
City : EVERETT
State : WA
Zip : 98208-7203
Country : US
Telephone Number : 425-836-1034
Fax Number :
Provider Business Practice Location Address
First Line : 22500 NE MARKETPLACE DR
Second Line : SUITE 204
City : REDMOND
State : WA
Zip : 98053-2033
Country : US
Telephone Number : 425-836-1034
Fax Number : 425-836-1037
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2009
Last Update Date : 01/25/2012

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Directions to “ MARY K JOHNSON LMP” Practice Location

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