Individual
MARY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
16334 COUNTY ROAD 30, MAPLE GROVE, MN 55311-1207
(763) 416-1799
Mailing address
16334 COUNTY ROAD 30, MAPLE GROVE, MN 55311-1207
(763) 416-1799
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
10/18/2016
Last updated
10/18/2016
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