Provider Demographics
NPI:1720250301
Name:JOHNSON, YOLANDA (LMT)
Entity Type:Individual
Prefix:MS
First Name:YOLANDA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 855
Mailing Address - Street 2:
Mailing Address - City:CLAYMONT
Mailing Address - State:DE
Mailing Address - Zip Code:19703-0855
Mailing Address - Country:US
Mailing Address - Phone:302-225-5841
Mailing Address - Fax:
Practice Address - Street 1:727 N MARKET ST
Practice Address - Street 2:SIDE ENTRANCE
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-4935
Practice Address - Country:US
Practice Address - Phone:302-225-5841
Practice Address - Fax:302-225-5841
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEMT-0002532225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist