Individual
MICHAEL GABRIEL JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7405 BUTTONWOOD DR, FORT WORTH, TX 76137-1308
(817) 353-4961
Mailing address
8316 TRACE RIDGE PKWY, FORT WORTH, TX 76137-5913
(817) 353-4961
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
MT104482
TX
225700000X
Massage Therapist
Primary
MT107482
TX
Other
Enumeration date
03/08/2018
Last updated
03/08/2018
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