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General NPI Number Information
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NPI Number | 1427656792
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Entity Type | Organization
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Legal Business Name | ELAINE JOHNSON LMT LCC
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Dates
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Enumeration Date | 10/09/2020
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Last Update Date | 10/09/2020
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Provider Practice Location Address
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Address Line | 811 CORAL RIDGE DR
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City | CORAL SPRINGS
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State | FL
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Zip | 33071-4180
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Country | US
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Telephone | 954-205-0299
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Fax |
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Provider Business Mailing Address
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Address Line | 811 CORAL RIDGE DR
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City | CORAL SPRINGS
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State | FL
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Zip | 33071-4180
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Country | US
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Telephone | 954-205-0299
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELAINE LENORE JOHNSON
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Credential | LMT
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Telephone | 954-205-0299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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