Provider Demographics
NPI:1346447935
Name:JOHNSON-DOAN, LAURA R
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:R
Last Name:JOHNSON-DOAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:R
Other - Last Name:DOAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:1920 E HALLANDALE BLVD
Mailing Address - Street 2:#901
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33314
Mailing Address - Country:US
Mailing Address - Phone:954-456-7777
Mailing Address - Fax:954-456-6726
Practice Address - Street 1:1920 E HALLANDALE BLVD
Practice Address - Street 2:#901
Practice Address - City:HALLANDALE
Practice Address - State:FL
Practice Address - Zip Code:33314
Practice Address - Country:US
Practice Address - Phone:954-456-7777
Practice Address - Fax:954-456-6726
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA#12603225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist