Provider Demographics
NPI:1205576121
Name:CARY, JOHANNA LEWIS (PT)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:LEWIS
Last Name:CARY
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 1:950 RIDGEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-4207
Mailing Address - Country:US
Mailing Address - Phone:850-865-7930
Mailing Address - Fax:
Practice Address - Street 1:4554 E HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-9755
Practice Address - Country:US
Practice Address - Phone:850-897-7772
Practice Address - Fax:888-308-1539
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT29151225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist