Provider Demographics
NPI:1023525391
Name:JOHNSON, CHRISTINE RENEE'
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:RENEE'
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3823 W CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6021
Mailing Address - Country:US
Mailing Address - Phone:337-658-3252
Mailing Address - Fax:
Practice Address - Street 1:3823 W CONGRESS ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6021
Practice Address - Country:US
Practice Address - Phone:337-658-3252
Practice Address - Fax:337-658-3252
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist