MEDICARE: DR. ALISA JOY JOHNSON L.M.T., PH.D.

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	92449	FL

General Provider Information

NPI Number	:	1821251273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALISA JOY JOHNSON L.M.T., PH.D.

Provider Business Mailing Address
First Line	:	7132 SW 4TH RD UNIT 216
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32607-6806
Country	:	US
Telephone Number	:	479-899-1794
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 FOREST HILLS BLVD
Second Line	:	STE 202
City	:	BELLA VISTA
State	:	AR
Zip	:	72715-3016
Country	:	US
Telephone Number	:	479-899-1794
Fax Number	:

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

Provider Enumeration Date	:	07/07/2008
Last Update Date	:	11/01/2020

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