MEDICARE: JENNIFER J JOHNS L.M.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA54342	FL

General Provider Information

NPI Number	:	1043444193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER J JOHNS L.M.T.

Provider Business Mailing Address
First Line	:	9475 NE 38TH TERR
Second Line	:
City	:	ANTHONY
State	:	FL
Zip	:	32617-3624
Country	:	US
Telephone Number	:	352-286-7436
Fax Number	:

Provider Business Practice Location Address
First Line	:	9475 NE 38TH TERR
Second Line	:
City	:	ANTHONY
State	:	FL
Zip	:	32617-3624
Country	:	US
Telephone Number	:	352-286-7436
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2009
Last Update Date	:	07/16/2012

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