Provider Demographics
NPI:1780909325
Name:JOHNSON, ANDREW DOUGLAS (LMP)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:DOUGLAS
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33427 PACIFIC HWY S
Mailing Address - Street 2:C-1
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6897
Mailing Address - Country:US
Mailing Address - Phone:253-874-2498
Mailing Address - Fax:253-248-1909
Practice Address - Street 1:33427 PACIFIC HWY S
Practice Address - Street 2:C-1
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6897
Practice Address - Country:US
Practice Address - Phone:253-874-2498
Practice Address - Fax:253-248-1909
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60115970225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist