Provider Demographics
NPI:1447916671
Name:JOHANSEN, CHARITY (LMT)
Entity type:Individual
Prefix:MS
First Name:CHARITY
Middle Name:
Last Name:JOHANSEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 VIA MARISOL APT 110
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-5128
Mailing Address - Country:US
Mailing Address - Phone:602-403-5235
Mailing Address - Fax:
Practice Address - Street 1:4141 VIA MARISOL APT 110
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-5128
Practice Address - Country:US
Practice Address - Phone:602-403-5235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86725225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist