Provider Demographics
NPI:1891112959
Name:HARDWICK, JOHNEEN D (CMT)
Entity Type:Individual
Prefix:
First Name:JOHNEEN
Middle Name:D
Last Name:HARDWICK
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:911 E SAN ANTONIO DR STE 5
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2204
Mailing Address - Country:US
Mailing Address - Phone:562-688-7716
Mailing Address - Fax:562-232-3728
Practice Address - Street 1:911 E SAN ANTONIO DR STE 5
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2204
Practice Address - Country:US
Practice Address - Phone:562-688-7716
Practice Address - Fax:562-232-3728
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2023-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA30480174400000X, 173C00000X, 225700000X, 175L00000X, 221700000X, 2255A2300X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist
No173C00000XOther Service ProvidersReflexologist
No175L00000XOther Service ProvidersHomeopath
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA30480OtherMASSAGE THERAPIST LICENSE