Individual
WYATT RICHARD JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
5261 N PORT WASHINGTON RD STE 101, MILWAUKEE, WI 53217-4903
(414) 332-6001
Mailing address
2861 N DOWNER AVE, MILWAUKEE, WI 53211-3756
(319) 333-4875
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
15697-146
WI
Other
Enumeration date
04/06/2023
Last updated
04/06/2023
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