Provider Demographics
NPI:1467979013
Name:JOHNSON, BRIAN R JR (LMT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:R
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 SW 160TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3003
Mailing Address - Country:US
Mailing Address - Phone:206-244-4263
Mailing Address - Fax:206-244-8703
Practice Address - Street 1:275 SW 160TH ST STE 201
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3003
Practice Address - Country:US
Practice Address - Phone:206-244-4263
Practice Address - Fax:206-244-4263
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60788102225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist