Maia Lyn Johnson, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

181913 Issued in AK

Practice address

Wild Iris Integrative Massage
550 S Alaska Street, Ste 104 C
Palmer, AK 99645

Phone

(907) 746-3270

NPI assigned

Nov 9, 2021

Last updated

Nov 9, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Practice roles

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

• Wild Iris Integrative Massage LLC

  • Massage Therapist
  • Palmer, AK
  • NPI 1750749800
  NPD (past)

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

{
    "created_epoch": "1636416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636416000000",
    "number": "1871259465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2521 E MOUNTAIN VILLAGE DR STE B",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547332",
            "telephone_number": "816-500-3680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "WILD IRIS INTEGRATIVE MASSAGE",
            "address_2": "550 S ALASKA STREET, STE 104 C",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "99645",
            "telephone_number": "907-746-3270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MAIA",
        "middle_name": "LYN",
        "name_prefix": "Ms.",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-09",
        "last_updated": "2021-11-09",
        "certification_date": "2021-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "AK",
            "license": "181913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah Christine Johnson
• Jaclyn H Johnson
• Jacquelyn Johnson, OTD/R/L
• La' Zayvia SM Johnson
• Lynsey Johnson
• Jolly Care Assisted Living Home LLC
• Pahleah Jones
• Virginia Rebecca Jones
• Jacob Nathaniel Jordan, PHARMD
• Mary Ann Jorgensen, RDN

• Massage Therapist in Palmer, AK
• Providers in Palmer, AK by specialty
• Massage Therapist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2021; 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.