Provider Demographics
NPI:1235143868
Name:JOHNSON, SIMONNE CHANTAL (ATC)
Entity Type:Individual
Prefix:MRS
First Name:SIMONNE
Middle Name:CHANTAL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 79TH AVE W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-3914
Mailing Address - Country:US
Mailing Address - Phone:253-460-0602
Mailing Address - Fax:
Practice Address - Street 1:5775 SOUNDVIEW DR
Practice Address - Street 2:SUITE B103
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-2211
Practice Address - Country:US
Practice Address - Phone:253-853-7956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer