Healthcare Provider Details

I. General information

NPI: 1821033804
Provider Name (Legal Business Name): JENNIFER ANN JOHNSON PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 NW 21ST AVE
CHIEFLAND FL
32626-1959
US

IV. Provider business mailing address

7350 SW COUNTY ROAD 334A
TRENTON FL
32693-6171
US

V. Phone/Fax

Practice location:
  • Phone: 352-493-2999
  • Fax: 352-493-0026
Mailing address:
  • Phone: 352-463-8144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT18767
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: