Individual
LISA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1507 S TUTTLE AVE, SARASOTA, FL 34239-2608
(941) 366-0336
Mailing address
2502 YUKON CLIFF DR, RUSKIN, FL 33570-6345
(813) 557-4299
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA24667
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA24667
BOARD LICENSE NUMBER
FL
Enumeration date
09/16/2022
Last updated
09/16/2022
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