Provider Demographics
NPI:1366770414
Name:JOHNSON, ROSANNA (LMT)
Entity type:Individual
Prefix:
First Name:ROSANNA
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 1:889 N LAKE SAMISH DR
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-9385
Mailing Address - Country:US
Mailing Address - Phone:360-739-3051
Mailing Address - Fax:
Practice Address - Street 1:1224 HARRIS AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7152
Practice Address - Country:US
Practice Address - Phone:360-733-8822
Practice Address - Fax:360-733-8843
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60115254225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist