Provider Demographics
NPI:1598740219
Name:JOHNSON, GAIL MARY (RPT)
Entity Type:Individual
Prefix:MISS
First Name:GAIL
Middle Name:MARY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9806 SW 222ND TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1521
Mailing Address - Country:US
Mailing Address - Phone:305-505-0887
Mailing Address - Fax:305-238-3600
Practice Address - Street 1:9806 SW 222ND TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33190-1521
Practice Address - Country:US
Practice Address - Phone:305-505-0887
Practice Address - Fax:305-238-3600
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20647225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y040WMedicare ID - Type Unspecified