Provider Demographics
NPI:1558566182
Name:JOHNSON, VIRGINIA (RN, LMT)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2586 23RD STREET
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1649
Mailing Address - Country:US
Mailing Address - Phone:330-388-7355
Mailing Address - Fax:
Practice Address - Street 1:2250 BROAD BLVD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1412
Practice Address - Country:US
Practice Address - Phone:330-923-4980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7515172M00000X, 225700000X
OH373397163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
No163W00000XNursing Service ProvidersRegistered Nurse
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist