Provider Demographics
NPI:1790924256
Name:JOHNSON, KARA (LMP)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15965 NE 85TH ST
Mailing Address - Street 2:102
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3593
Mailing Address - Country:US
Mailing Address - Phone:425-882-9065
Mailing Address - Fax:425-558-1900
Practice Address - Street 1:15965 NE 85TH ST
Practice Address - Street 2:102
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3593
Practice Address - Country:US
Practice Address - Phone:425-882-9065
Practice Address - Fax:425-558-1900
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60049088174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60049088OtherMASSAGE THERAPY