Provider Demographics
NPI:1407159577
Name:CORRALES, JOHANNA KAY (CPM, LMT)
Entity type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:KAY
Last Name:CORRALES
Suffix:
Gender:F
Credentials:CPM, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7277 OAKMONT DR STE D
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-1330
Mailing Address - Country:US
Mailing Address - Phone:561-512-0613
Mailing Address - Fax:
Practice Address - Street 1:7277 OAKMONT DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-1330
Practice Address - Country:US
Practice Address - Phone:561-512-0613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA55216225700000X
FLMW484176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist