Provider Demographics
NPI:1508124801
Name:JOHNSON, DEBORAH MARIE (CMT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47100 SCHOENHERR RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-4716
Mailing Address - Country:US
Mailing Address - Phone:586-685-0505
Mailing Address - Fax:
Practice Address - Street 1:47100 SCHOENHERR RD
Practice Address - Street 2:SUITE D
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-4716
Practice Address - Country:US
Practice Address - Phone:586-685-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist