Individual
CYNTHIA DIANE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICENSED MASSAGE TH
Contact information
Practice address
119 N BROADWAY AVE STE 10, ADA, OK 74820-5052
(580) 399-3699
Mailing address
14184 COUNTY ROAD 1573, ADA, OK 74820-1552
(580) 399-3699
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
184331
OK
Other
Enumeration date
11/12/2020
Last updated
11/12/2020
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