Provider Demographics
NPI:1043444193
Name:JOHNS, JENNIFER J (LMT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:JOHNS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9475 NE 38TH TERR
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:FL
Mailing Address - Zip Code:32617-3624
Mailing Address - Country:US
Mailing Address - Phone:352-286-7436
Mailing Address - Fax:
Practice Address - Street 1:9475 NE 38TH TERR
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:FL
Practice Address - Zip Code:32617-3624
Practice Address - Country:US
Practice Address - Phone:352-286-7436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA54342225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist