Basic Information
| Provider Information | |||||||||
| NPI: | 1003003138 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON-FENTER | ||||||||
| FirstName: | TRICIA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LMP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 946 | ||||||||
| Address2: | |||||||||
| City: | SNOHOMISH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982910946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605630629 | ||||||||
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| Practice Location | |||||||||
| Address1: | 119 UNION AVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | SNOHOMISH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982902942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605630629 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2007 | ||||||||
| LastUpdateDate: | 10/02/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | MA00024629 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.