Individual
MRS. RUNAKO AYANA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1316 SOUTH BLVD W, DAVENPORT, FL 33837-9093
(863) 421-0556
Mailing address
8423 GREYSTONE DR, LAKELAND, FL 33810-2081
(863) 868-9901
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA 20213
FL
Other
Enumeration date
05/24/2007
Last updated
07/08/2007
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