Provider Demographics
NPI:1821251273
Name:JOHNSON, ALISA JOY (LMT, PHD)
Entity Type:Individual
Prefix:DR
First Name:ALISA
Middle Name:JOY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7132 SW 4TH RD UNIT 216
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-6806
Mailing Address - Country:US
Mailing Address - Phone:479-899-1794
Mailing Address - Fax:
Practice Address - Street 1:1801 FOREST HILLS BLVD
Practice Address - Street 2:STE 202
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72715-3016
Practice Address - Country:US
Practice Address - Phone:479-899-1794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL92449225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist