Provider Demographics
NPI:1992058010
Name:JOHNSEN, ELIZABETH M (LMT,CMT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:JOHNSEN
Suffix:
Gender:F
Credentials:LMT,CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 809
Mailing Address - Street 2:507 MAIN ST C
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-0809
Mailing Address - Country:US
Mailing Address - Phone:970-668-8155
Mailing Address - Fax:970-668-1301
Practice Address - Street 1:507 C MAIN ST
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-668-8155
Practice Address - Fax:970-668-1301
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4640172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist