Provider Demographics
NPI:1225301617
Name:HARTLEY, JOHANNA RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:RAY
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:RAY
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:5503 38TH AVE N.
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710
Mailing Address - Country:US
Mailing Address - Phone:302-222-4070
Mailing Address - Fax:727-245-6050
Practice Address - Street 1:5503 38TH AVE N.
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710
Practice Address - Country:US
Practice Address - Phone:302-222-4070
Practice Address - Fax:727-245-6050
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10446111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor