Healthcare Provider Details

I. General information

NPI: 1114832904
Provider Name (Legal Business Name): EVA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 RACETRACK RD NW STE 20
FORT WALTON BEACH FL
32547-1581
US

IV. Provider business mailing address

606 AVENUE DE LA DAUPHINE
MARY ESTHER FL
32569-2341
US

V. Phone/Fax

Practice location:
  • Phone: 850-347-8158
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: