Individual
JACQUELINE MARY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3205 E 3RD ST, PANAMA CITY, FL 32401-5644
(850) 527-0462
Mailing address
3205 E 3RD ST, PANAMA CITY, FL 32401-5644
(850) 527-0462
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA21285
FL
Other
Enumeration date
08/10/2009
Last updated
08/10/2009
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