Provider Demographics
NPI:1952570467
Name:ROBERTSON-JOHNSON, ALLESE MARCELLA (LMP)
Entity Type:Individual
Prefix:
First Name:ALLESE
Middle Name:MARCELLA
Last Name:ROBERTSON-JOHNSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18120 97TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3324
Mailing Address - Country:US
Mailing Address - Phone:425-481-1933
Mailing Address - Fax:425-481-9371
Practice Address - Street 1:18120 97TH AVE NE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3324
Practice Address - Country:US
Practice Address - Phone:425-481-1933
Practice Address - Fax:425-481-9371
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021702225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist