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General NPI Number Information
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NPI Number | 1811927767
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Entity Type | Individual
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Provider Name | BRENDA WILLIS JOHNS L.M.T.
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Gender | Female
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 08/25/2009
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Provider Practice Location Address
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Address Line | 2177 KINGSLEY AVE SUITE 11
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City | ORANGE PARK
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State | FL
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Zip | 32073-5199
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Country | US
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Telephone | 904-298-7665
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Fax | 904-278-8060
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Provider Business Mailing Address
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Address Line | 1867 NOLAN RD
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City | MIDDLEBURG
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State | FL
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Zip | 32068-3071
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Country | US
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Telephone | 904-298-7665
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Fax | 904-278-8060
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA26981
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License Number State | FL
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