Doctor Name: | KELLY JOHNSON |
NPI Number: | 1245582527 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | MT20902165 |
Business Practice Address: | 10385 Commerce Dr Suite22 Carmel, IN - 460327630 |
Business Phone Number: | 3176601342 |
Business Fax Number: | |
Mailing Address: | 3528 Alpine Pl, INDIANAPOLIS |
State: | IN |
Postal Code: | 462266441 |
Phone Number: | 3179189043 |
Fax Number: | |
NPI Enumeration Date: | 10/10/2012 |
NPI Last Update Date: | 10/10/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MT20902165 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |