Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MSG005875 | PA |
NPI | 1013262229 |
---|---|
Provider Name | Mrs. Erica C Johnson |
First Address | Philadelphia, PA 19118-4421 |
Second Address | Philadelphia, PA 19150-3611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2012 |
Last Update Date | 14/07/2012 |