Provider Demographics
NPI:1023332368
Name:JOHNSON, CLEVELAND ROY (RRT)
Entity type:Individual
Prefix:MR
First Name:CLEVELAND
Middle Name:ROY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18651 SW 128TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-3035
Mailing Address - Country:US
Mailing Address - Phone:305-255-8981
Mailing Address - Fax:305-234-3336
Practice Address - Street 1:18651 SW 128TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-3035
Practice Address - Country:US
Practice Address - Phone:305-255-8981
Practice Address - Fax:305-234-3336
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRRT 82392279C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredCritical Care