Basic Information
| Provider Information | |||||||||
| NPI: | 1679144513 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARAHONA | ||||||||
| FirstName: | JOANNE | ||||||||
| MiddleName: | LUMABAN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3680 N WICKHAM RD STE B | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329352327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3212555500 | ||||||||
| FaxNumber: | 2512555551 | ||||||||
| Practice Location | |||||||||
| Address1: | 3680 N WICKHAM RD STE B | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329352327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3212555500 | ||||||||
| FaxNumber: | 3212555551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2021 | ||||||||
| LastUpdateDate: | 07/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT37193 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.