Provider Demographics
NPI:1649419425
Name:JOHNSON, CHRISTIE E (BA, MT)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BA, MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31045 AVENIDA DEL REPOSO
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-1715
Mailing Address - Country:US
Mailing Address - Phone:951-587-9156
Mailing Address - Fax:951-587-9157
Practice Address - Street 1:31045 AVENIDA DEL REPOSO
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-1715
Practice Address - Country:US
Practice Address - Phone:951-587-9156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist