Provider Demographics
NPI:1760709075
Name:JOHNSON-SWARTZ, TERA J (CMT, LMT)
Entity Type:Individual
Prefix:
First Name:TERA
Middle Name:J
Last Name:JOHNSON-SWARTZ
Suffix:
Gender:F
Credentials:CMT, LMT
Other - Prefix:
Other - First Name:TERA
Other - Middle Name:J
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMT, LMT
Mailing Address - Street 1:443 S CORONA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-2413
Mailing Address - Country:US
Mailing Address - Phone:615-925-2288
Mailing Address - Fax:
Practice Address - Street 1:443 S CORONA
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209
Practice Address - Country:US
Practice Address - Phone:615-925-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174H00000X
CA879247200000X
TN8469247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No174H00000XOther Service ProvidersHealth Educator