Provider Demographics
NPI:1891237657
Name:JOHNSON, SARAH MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11260 OLD SEWARD HWY
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3098
Mailing Address - Country:US
Mailing Address - Phone:907-341-5555
Mailing Address - Fax:907-341-5755
Practice Address - Street 1:11260 OLD SEWARD HWY
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3098
Practice Address - Country:US
Practice Address - Phone:907-341-5555
Practice Address - Fax:907-341-5755
Is Sole Proprietor?:No
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK114532174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist