Provider Demographics
NPI:1205971637
Name:JOHNSON, MELISSA A (DPT)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16030 BOTHELL EVERETT HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1273
Mailing Address - Country:US
Mailing Address - Phone:425-745-4910
Mailing Address - Fax:425-338-5709
Practice Address - Street 1:16030 BOTHELL EVERETT HWY STE 200
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1273
Practice Address - Country:US
Practice Address - Phone:425-745-4910
Practice Address - Fax:425-338-5709
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008981225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3254JOOtherREGENCE
WA0180263OtherDEPT. OF L&I
WA8363954Medicaid
WA8363954Medicaid