Provider Demographics
NPI:1770600629
Name:JOHNSON, REBECCA RAE (MA, ATC,CSCS)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:RAE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, ATC,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7035 LAZY CT SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-7410
Mailing Address - Country:US
Mailing Address - Phone:408-230-3023
Mailing Address - Fax:
Practice Address - Street 1:2700 EVERGREEN PKWY NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98505-0001
Practice Address - Country:US
Practice Address - Phone:360-867-6587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer