Healthcare Provider Details

I. General information

NPI: 1477988152
Provider Name (Legal Business Name): HELEN S JOHNSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2013
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 SATELLITE BLVD
ORLANDO FL
32837-8464
US

IV. Provider business mailing address

2042 JAFFA CT
CLERMONT FL
34714-7265
US

V. Phone/Fax

Practice location:
  • Phone: 407-859-5656
  • Fax:
Mailing address:
  • Phone: 352-243-4488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number24280
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: