Individual ProviderMallory Marie JohnsonMassage TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address670 NW Gilman Blvd, Suite #B2, Issaquah, WA 98027-2444(425) 427-6562(206) 714-4355PECOS EnrollmentBased on the most recent information from CMS, provider Mallory Marie Johnson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1992034144Provider TypeIndividualFull NameJohnson, Mallory MarieCredentialLMPGenderFemaleSole ProprietorNoEnumeration Date12/17/2009Last Updated12/17/2009Contact InformationPractice LocationPractice Address670 NW Gilman Blvd, Suite #B2, Issaquah, WA 98027-2444Phone(425) 427-6562FaxUnlisted FaxMailing LocationMailing Address13031 123rd Ln NE, D202, Kirkland, WA 98034-7344Phone(206) 714-4355FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225700000XPrimaryDescriptionMassage TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicenseMA60119122Washington