Provider Demographics
NPI:1407159577
Name:SMITH, JOHANNA KAY (LMT)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:KAY
Last Name:SMITH
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 1:1011 N STATE ROAD 7
Mailing Address - Street 2:SUITE D
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-5184
Mailing Address - Country:US
Mailing Address - Phone:561-333-8353
Mailing Address - Fax:
Practice Address - Street 1:1011 N STATE ROAD 7
Practice Address - Street 2:SUITE D
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-5184
Practice Address - Country:US
Practice Address - Phone:561-333-8353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA55216225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist