Provider Demographics
NPI:1164043337
Name:STOISAVLEJEVIC, JOHANNA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:STOISAVLEJEVIC
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:951 ELMA G MILES PKWY
Mailing Address - Street 2:STE B
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313
Mailing Address - Country:US
Mailing Address - Phone:912-876-2206
Mailing Address - Fax:912-877-4030
Practice Address - Street 1:951 ELMA G MILES PKWY
Practice Address - Street 2:STE B
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313
Practice Address - Country:US
Practice Address - Phone:912-876-2206
Practice Address - Fax:912-877-4030
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT012084225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist