Provider Demographics
NPI:1235369851
Name:JOHNSON, BRIANA
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:
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 1:1322 FOX ST
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-8731
Mailing Address - Country:US
Mailing Address - Phone:763-807-6836
Mailing Address - Fax:
Practice Address - Street 1:620 BABCOCK BLVD E
Practice Address - Street 2:SUITE 5
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-8603
Practice Address - Country:US
Practice Address - Phone:763-807-6836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist