Provider Demographics
NPI:1083146674
Name:JOHNSON, TAYLOR NICHOLE
Entity Type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:NICHOLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649 E BEACON LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99217-8748
Mailing Address - Country:US
Mailing Address - Phone:509-590-5982
Mailing Address - Fax:
Practice Address - Street 1:1649 E BEACON LN
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99217-8748
Practice Address - Country:US
Practice Address - Phone:509-590-5982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-01
Last Update Date:2017-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist