Lydia Alice Johnson
Specialist/Technologist, Athletic Trainer in Brockport, NY. Individual provider (NPI-1).
NPI number1235859778
StatusActive
Last updated in NPPESSep 2, 2022
Details
- NPI
- 1235859778
- Entity type
- Individual (NPI-1)
- Name
- Lydia Alice Johnson
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Sep 2, 2022
- Certification date
- Sep 2, 2022
- Last updated
- Sep 2, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | 004486 | NY | Yes |
Practice location
350 New Campus DrBrockport, NY 14420-2914
Phone 585-395-5374
Mailing address
636 Park Hill RdErin, NY 14838-9755
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