Provider Demographics
NPI:1871894287
Name:JOHNSON, JOHNSON MARIA FRIEDERIKE (LMP)
Entity type:Individual
Prefix:MRS
First Name:JOHNSON
Middle Name:MARIA FRIEDERIKE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10316 107TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-1583
Mailing Address - Country:US
Mailing Address - Phone:253-306-3041
Mailing Address - Fax:
Practice Address - Street 1:1175 CENTER DR STE 160
Practice Address - Street 2:
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327-7734
Practice Address - Country:US
Practice Address - Phone:253-964-1559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60141193225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist