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NPI Code Detail

MEDICARE: MISS LAUREN MARY JOHNSON ATC, LAT, ARRT (MRI)

MEDICARE:  MISS LAUREN MARY JOHNSON  ATC, LAT, ARRT (MRI)
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer0415AZ

General Provider Information

NPI Number : 1841280526
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS LAUREN MARY JOHNSON ATC, LAT, ARRT (MRI)
Provider Business Mailing Address
First Line : 13809 N 49TH AVE
Second Line :
City : GLENDALE
State : AZ
Zip : 85306-4922
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5555 W THUNDERBIRD RD
Second Line :
City : GLENDALE
State : AZ
Zip : 85306-4622
Country : US
Telephone Number : 602-865-5594
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2005
Last Update Date : 04/17/2025

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Directions to “ MISS LAUREN MARY JOHNSON ATC, LAT, ARRT (MRI)” Practice Location

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