Provider Demographics
NPI:1003661539
Name:JOHNSON, ALMETRIS WATKINS (LMBT, RMT)
Entity Type:Individual
Prefix:
First Name:ALMETRIS
Middle Name:WATKINS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMBT, RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4112 RANDALL PKWY UNIT 2G
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2815
Mailing Address - Country:US
Mailing Address - Phone:910-633-4653
Mailing Address - Fax:
Practice Address - Street 1:5102 WRIGHTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7054
Practice Address - Country:US
Practice Address - Phone:910-409-5640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10027225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist