Andrea M Johnson, LMT
Individual provider Active NPI Massage Therapist · Bridgton, ME
NPI 1104398015 · NPPES record last updated Dec 18, 2018
Key facts
- NPI
- 1104398015
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- MT4770 (ME)
- Practice address
- 27 Sandy Creek Rd
Bridgton, ME 04009-4134 - Phone
- (207) 256-7149
- NPI assigned
- Dec 18, 2018
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT4770 | ME | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MT4770 | ME | Yes |
Addresses
Primary practice location
27 Sandy Creek Rd
Bridgton, ME 04009-4134
Mailing address
854 Stow Rd
Stow, ME 04037-3234
Other providers in Bridgton, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 18, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.