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Individual

MANDA LYNN JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LMT

Contact information

Practice address
N82W15485 APPLETON AVE, MENOMONEE FALLS, WI 53051-3711
(262) 251-2929
Mailing address
W215N10083 HICKORY DR, COLGATE, WI 53017-9511
(262) 613-9872

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
11999-146
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
11999-146
MASSAGE THERAPIST
WI
Enumeration date
06/17/2019
Last updated
06/17/2019
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