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General NPI Number Information
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NPI Number | 1427263854
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Entity Type | Individual
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Provider Name | TAMMY RACHANTE JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3505 LAKE LYNDA DR., SUITE 207
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City | ORLANDO
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State | FL
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Zip | 32817-8327
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Country | US
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Telephone | 800-774-7785
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Fax |
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Provider Business Mailing Address
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Address Line | 1814 EMERSON AVE
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City | ATLANTIC CITY
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State | NJ
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Zip | 08401-1506
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Country | US
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Telephone | 609-513-2472
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT40QA01019000
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License Number State | NJ
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