Provider Demographics
NPI:1245351238
Name:JOHNSON, DEBE ANNE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:DEBE
Middle Name:ANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 ESMERELDA DR.
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86429-1124
Mailing Address - Country:US
Mailing Address - Phone:928-404-4054
Mailing Address - Fax:
Practice Address - Street 1:2065 HWY 95
Practice Address - Street 2:STE 51
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442
Practice Address - Country:US
Practice Address - Phone:928-763-4737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT - 06853174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist