Individual
STAR JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
201 THORNBERRY BRANCH LN, DAYTONA BEACH, FL 32124-3652
(386) 872-4892
(386) 256-2159
Mailing address
201 THORNBERRY BRANCH LN, DAYTONA BEACH, FL 32124-3652
(386) 872-4892
(386) 256-2159
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
Other
Enumeration date
01/04/2018
Last updated
01/04/2018
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