Provider Demographics
NPI:1437621596
Name:JOHNSON, ALYSSA MCKENZY (LMT)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MCKENZY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10515 198TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-7701
Mailing Address - Country:US
Mailing Address - Phone:253-250-2054
Mailing Address - Fax:
Practice Address - Street 1:11216 SUNRISE BLVD E STE 3-108
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-8848
Practice Address - Country:US
Practice Address - Phone:253-604-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60911218225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist