Provider Demographics
NPI:1659642130
Name:LAMANILAO, JOHANNA JOY (PT)
Entity Type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:JOY
Last Name:LAMANILAO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 HERONS RUN DR APT 512
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-1747
Mailing Address - Country:US
Mailing Address - Phone:941-565-2392
Mailing Address - Fax:
Practice Address - Street 1:1507 S TUTTLE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2608
Practice Address - Country:US
Practice Address - Phone:941-366-0366
Practice Address - Fax:941-366-9376
Is Sole Proprietor?:No
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23778225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist