Healthcare Provider Details

I. General information

NPI: 1821251273
Provider Name (Legal Business Name): ALISA JOY JOHNSON L.M.T., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 11/01/2020
Certification Date: 11/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 FOREST HILLS BLVD STE 202
BELLA VISTA AR
72715-3016
US

IV. Provider business mailing address

7132 SW 4TH RD UNIT 216
GAINESVILLE FL
32607-6806
US

V. Phone/Fax

Practice location:
  • Phone: 479-899-1794
  • Fax:
Mailing address:
  • Phone: 479-899-1794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number92449
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: