Provider Demographics
NPI:1265065346
Name:MK JOHNSON, LLC DBA
Entity type:Organization
Organization Name:MK JOHNSON, LLC DBA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MALIA
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMBT
Authorized Official - Phone:828-527-8051
Mailing Address - Street 1:55 LITTLE WOODS LN
Mailing Address - Street 2:
Mailing Address - City:OLD FORT
Mailing Address - State:NC
Mailing Address - Zip Code:28762-8651
Mailing Address - Country:US
Mailing Address - Phone:407-403-3728
Mailing Address - Fax:
Practice Address - Street 1:1141 MONTREAT RD
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-3231
Practice Address - Country:US
Practice Address - Phone:828-527-8051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty