Provider Demographics
NPI:1164224986
Name:MILLS, JOANNA GRACE (LMT)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:GRACE
Last Name:MILLS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 SW HOLDEN ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-1881
Mailing Address - Country:US
Mailing Address - Phone:206-354-8054
Mailing Address - Fax:
Practice Address - Street 1:3416B SW CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-4036
Practice Address - Country:US
Practice Address - Phone:206-354-8054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61432598225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist