Individual
LISA M JOHNSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1200 MIRA MAR AVE, C/O EMA'S SALON, MEDFORD, OR 97504
(541) 857-7365
Mailing address
860 S OREGON ST, JACKSONVILLE, OR 97530-9321
(541) 499-5962
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18862
OR
Other
Enumeration date
01/31/2013
Last updated
09/16/2013
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