Provider Demographics
NPI:1003003138
Name:JOHNSON-FENTER, TRICIA L (LMP)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:L
Last Name:JOHNSON-FENTER
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:PO BOX 946
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98291-0946
Mailing Address - Country:US
Mailing Address - Phone:360-563-0629
Mailing Address - Fax:
Practice Address - Street 1:119 UNION AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2942
Practice Address - Country:US
Practice Address - Phone:360-563-0629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024629225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist