Provider Demographics
NPI:1285940643
Name:JOHNSON, DARREL LYNN (LMT)
Entity type:Individual
Prefix:MR
First Name:DARREL
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30310 ALDINE WESTFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-3355
Mailing Address - Country:US
Mailing Address - Phone:281-923-4816
Mailing Address - Fax:
Practice Address - Street 1:30310 ALDINE WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-3355
Practice Address - Country:US
Practice Address - Phone:281-923-4816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107962225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX107962OtherMASSAGE