Provider Demographics
NPI:1962642728
Name:JOHNSON, MELANIE K (LMP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:K
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 1:5800 SOUNDVIEW DR
Mailing Address - Street 2:STE C-101
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-2000
Mailing Address - Country:US
Mailing Address - Phone:253-858-4845
Mailing Address - Fax:253-857-8305
Practice Address - Street 1:5800 SOUNDVIEW DR
Practice Address - Street 2:STE C-101
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-2000
Practice Address - Country:US
Practice Address - Phone:253-858-4845
Practice Address - Fax:253-857-8305
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60058439225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist