Wyatt Richard Johnson, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

15697-146 Issued in WI

Practice address

5261 N Port Washington Rd Ste 101
Milwaukee, WI 53217-4903

Phone

(414) 332-6001

NPI assigned

Apr 6, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1680739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680739200000",
    "number": "1194410100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2861 N DOWNER AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532113756",
            "telephone_number": "319-333-4875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5261 N PORT WASHINGTON RD STE 101",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532174903",
            "telephone_number": "414-332-6001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "WYATT",
        "middle_name": "RICHARD",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-06",
        "last_updated": "2023-04-06",
        "certification_date": "2023-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WI",
            "license": "15697-146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tyler Monroe Johnson, DO
• Tyonna Johnson
• Tyrone Johnson
• Vanessa Denise Johnson, RN, CLS, DOULA
• Victor Adegoke Johnson
• Yun Johnson
• Zhaneane Johnson
• Daniel O Johnsrud, MD
• Alexander Jordon Johnston, MD
• Bryan Johnston

• Massage Therapist in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Massage Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2023; 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.