Individual
KELLY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
1030 MINERS RD, SAINT JOSEPH, MI 49085-9625
(269) 408-1688
(269) 408-1692
Mailing address
2787 PHILLIPS DR, STEVENSVILLE, MI 49127-1007
(269) 208-8558
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501001593
MI
Other
Enumeration date
09/15/2016
Last updated
09/15/2016
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