Provider Demographics
NPI:1952511206
Name:JOHNSON, ALLYSON (LMP)
Entity Type:Individual
Prefix:MRS
First Name:ALLYSON
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MRS
Other - First Name:ALLYSON
Other - Middle Name:
Other - Last Name:BEECHINOR-LARSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:1505 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-1721
Mailing Address - Country:US
Mailing Address - Phone:425-252-9132
Mailing Address - Fax:425-252-9714
Practice Address - Street 1:1505 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1721
Practice Address - Country:US
Practice Address - Phone:425-252-9132
Practice Address - Fax:425-252-9714
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA19538225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist