Individual provider Active NPI

Jill A Johnson, LMP

  • Massage Therapist
  • Vancouver, WA
National Provider Identifier
1124148655
Registry record updated Apr 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
MA0020602 Issued in WA
Practice address
9106 NE Highway 99 Ste H
Suite H
Vancouver, WA 98665-8949
Phone
(360) 601-0111
Fax
(360) 546-2473
NPI assigned
Mar 29, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 25, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X MA0020602 WA Primary

Addresses

Primary practice location

9106 NE Highway 99 Ste H
Suite H
Vancouver, WA 98665-8949

Mailing address

800 NE Tenney Rd
#110-531
Vancouver, WA 98685-2831
Phone (360) 601-0111

Other names 1

  • Healing Massage Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
MA0020602WAMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Barnick Chiropractic, PS Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366848000000",
    "number": "1124148655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 NE TENNEY RD",
            "address_2": "#110-531",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986852831",
            "telephone_number": "360-601-0111",
            "fax_number": "360-546-2473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9106 NE HIGHWAY 99 STE H",
            "address_2": "SUITE H",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986658949",
            "telephone_number": "360-601-0111",
            "fax_number": "360-546-2473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JILL",
        "middle_name": "A",
        "credential": "LMP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-29",
        "last_updated": "2013-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA0020602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEALING",
            "last_name": "MASSAGE",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.