Provider Demographics
NPI:1639317746
Name:JOHNSON, ALAN CURTIS (LMP)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:CURTIS
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:WA
Mailing Address - Zip Code:99005-0351
Mailing Address - Country:US
Mailing Address - Phone:509-481-1689
Mailing Address - Fax:
Practice Address - Street 1:10925 N NEWPORT HWY STE 10
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1646
Practice Address - Country:US
Practice Address - Phone:509-468-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA548088-07225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist