Healthcare Provider Details

I. General information

NPI: 1720943251
Provider Name (Legal Business Name): CHELSEA JOHNSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 S LAKEWOOD DR
BRANDON FL
33511-5015
US

IV. Provider business mailing address

3907 PIPPIN RD
PLANT CITY FL
33567-2639
US

V. Phone/Fax

Practice location:
  • Phone: 813-978-9700
  • Fax:
Mailing address:
  • Phone: 813-750-2336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTA32331
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: