Provider Demographics
NPI:1245908102
Name:GOMEZ ESCALONA, JOHANNY (LMT)
Entity type:Individual
Prefix:
First Name:JOHANNY
Middle Name:
Last Name:GOMEZ ESCALONA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 SW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-2809
Mailing Address - Country:US
Mailing Address - Phone:305-240-3233
Mailing Address - Fax:
Practice Address - Street 1:1241 SW 29TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33315-2809
Practice Address - Country:US
Practice Address - Phone:305-240-3233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA63247225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty